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IN THE SOUTH ISLAND
3
The Health Status of
Children and Young People
in the
South Island
This report was prepared for the South Island Alliance Programme by Elizabeth Craig, Judith Adams, Glenda Oben, Anne Reddington, Andrew
Wicken and Jean Simpson on behalf of the NZ Child and Youth Epidemiology Service, November 2011
This report was produced as the result of a contract between the Canterbury DHB (on behalf of the South Island Alliance Programme) and the University of Otago (on behalf of the NZ Child and Youth Epidemiology Service (NZCYES). The NZCYES is located in the Department of Women’s and Children’s Health at the University of Otago’s Dunedin School of Medicine. While every endeavour has been made to use accurate data in this report, there are currently variations in the way data are collected from DHBs and other agencies that may result in errors, omissions or inaccuracies in the information in this report. The NZCYES does not accept liability for any inaccuracies arising from the use of these data in the production of these reports, or for any losses arising as a consequence thereof.
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Cover Artwork: Pepe Para Riki - Common Copper Butterfly by John Gillespie
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TABLE OF CONTENTS
Table of Contents ............................................................................................................ 5
List of Figures .................................................................................................................. 7
List of Tables ................................................................................................................. 16
INTRODUCTION AND OVERVIEW.................................................................................. 27
Introduction and Overview ............................................................................................. 29
THE HEALTH STATUS OF CHILDREN AND YOUNG PEOPLE ...................................... 45
ISSUES MORE COMMON IN INFANCY .......................................................................... 47
Regional Births .............................................................................................................. 49
Fetal Deaths .................................................................................................................. 54
Preterm Birth ................................................................................................................. 73
Infant Mortality and Sudden Unexpected Death in Infancy ............................................. 83
Total Infant, Neonatal and Post Neonatal Mortality .................................................... 83
Sudden Unexpected Death in Infancy (SUDI) ............................................................ 92
Breastfeeding .............................................................................................................. 100
ISSUES MORE COMMON IN CHILDREN, OR CHILDREN AND YOUNG PEOPLE ...... 113
TOTAL AVOIDABLE MORBIDITY AND MORTALITY .................................................... 115
In-Depth Topic: Models of Primary Care for Children ................................................... 117
Most Frequent Causes of Hospital Admission and Mortality in Children ....................... 135
Ambulatory Sensitive Hospitalisations ......................................................................... 146
INFECTIOUS AND RESPIRATORY DISEASES ............................................................ 163
Introduction to Infectious and Respiratory Diseases Section ........................................ 165
UPPER RESPIRATORY TRACT CONDITIONS ............................................................. 173
Acute Upper Respiratory Infections and Tonsillectomy in Children .............................. 175
Acute Upper Respiratory Tract Infections ................................................................ 176
Tonsillectomy .......................................................................................................... 184
Middle Ear Conditions: Otitis Media and Grommets ..................................................... 197
LOWER RESPIRATORY TRACT CONDITIONS ............................................................ 215
Bronchiolitis ................................................................................................................. 217
Pneumonia .................................................................................................................. 227
Asthma ........................................................................................................................ 242
Bronchiectasis ............................................................................................................. 255
INFECTIOUS DISEASES ............................................................................................... 265
Pertussis ...................................................................................................................... 267
Meningococcal Disease ............................................................................................... 275
Tuberculosis ................................................................................................................ 284
Rheumatic Fever and Heart Disease ........................................................................... 292
Serious Skin Infections ................................................................................................ 302
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Gastroenteritis ............................................................................................................. 321
OTHER ISSUES ............................................................................................................. 335
Injuries in Children ....................................................................................................... 337
Oral Health: School Dental Service Data and Dental Caries Admissions ..................... 363
School Dental Service Data ..................................................................................... 363
Hospital Admissions for Dental Caries ..................................................................... 371
Permanent Hearing Loss ............................................................................................. 392
Deafness Notification Database .............................................................................. 392
Newborn Hearing Screening ................................................................................... 396
ISSUES MORE COMMON IN YOUNG PEOPLE ............................................................ 405
In Depth Topic: Models of Primary Health Care Delivery for Young People ................. 407
Most Frequent Causes of Hospital Admission and Mortality in Young People .............. 426
Injuries in Young People .............................................................................................. 438
Teenage Pregnancy .................................................................................................... 461
Terminations of Pregnancy .......................................................................................... 472
THE CHILDREN’S SOCIAL HEALTH MONITOR: INTRODUCTION .............................. 483
Introduction to the Children’s Social Health Monitor ..................................................... 485
THE CHILDREN’S SOCIAL HEALTH MONITOR: ECONOMIC INDICATORS ............... 487
Gross Domestic Product (GDP) ................................................................................... 489
Income Inequality ......................................................................................................... 491
Child Poverty and Living Standards ............................................................................. 494
Unemployment Rates .................................................................................................. 503
Children Reliant on Benefit Recipients ......................................................................... 510
THE CHILDREN’S SOCIAL HEALTH MONITOR: HEALTH AND WELLBEING INDICATORS ................................................................................................................. 517
Hospital Admissions and Mortality with a Social Gradient in Children .......................... 519
Injuries Arising from the Assault, Neglect or Maltreatment of Children ......................... 541
APPENDICES AND REFERENCES ............................................................................... 549
Appendix 1: Search Methods for Policy Documents and Evidence-Based Reviews ..... 551
Appendix 2: Statistical Significance Testing and its use in this Report ......................... 553
Appendix 3: the National Minimum Dataset ................................................................. 555
Appendix 4: The Birth Registration Dataset ................................................................. 559
Appendix 5: National Mortality Collection ..................................................................... 560
Appendix 6: Measurement of Ethnicity ......................................................................... 561
Appendix 7: NZ Deprivation Index................................................................................ 565
Appendix 8: Ambulatory Sensitive Hospital Admissions ............................................... 566
Appendix 9: Methods Used to Develop the Children’s Social Health Monitor ............... 569
References .................................................................................................................. 572
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LIST OF FIGURES
Figure 1. Intermediate and Late Fetal Deaths, New Zealand 2000–2008 ....................... 58
Figure 2. Fetal Deaths by Gestational Age and Main Fetal Cause of Death, New Zealand 2004–2008 ....................................................................................................... 58
Figure 3. Intermediate and Late Fetal Deaths and Unspecified Deaths by Ethnicity, New Zealand 2000–2008 ............................................................................................... 59
Figure 4. Intermediate and Late Fetal Deaths, South Island DHBs vs. New Zealand 2000−2008..................................................................................................................... 62
Figure 5. Preterm Birth Rates in Singleton Live Born Babies by Ethnicity, New Zealand 2000−2010 ....................................................................................................... 75
Figure 6. Preterm Birth Rates in Singleton Live Born Babies, South Island DHBs vs. New Zealand 2000−2010 ......................................................................................... 76
Figure 7. Preterm Birth Rates in Singleton Live Born Babies by Ethnicity, South Island DHBs vs. New Zealand 2000−2010 ..................................................................... 77
Figure 8. Total Infant, Neonatal and Post Neonatal Mortality, New Zealand 1990−2008..................................................................................................................... 84
Figure 9. Total Infant, Neonatal and Post Neonatal Mortality by Ethnicity, New Zealand 1996−2008 ....................................................................................................... 84
Figure 10. Total Infant Mortality, South Island DHBs vs. New Zealand 1990−2008 ........ 87
Figure 11. Neonatal and Post Neonatal Mortality, South Island DHBs vs. New Zealand 1990−2008 ....................................................................................................... 88
Figure 12. Sudden Unexpected Death in Infancy by Type, New Zealand 1996−2008..................................................................................................................... 92
Figure 13. Sudden Unexpected Death in Infancy by Type and Age in Weeks, New Zealand 2004−2008 ....................................................................................................... 93
Figure 14. Sudden Unexpected Death in Infancy by Ethnicity, New Zealand 1996−2008..................................................................................................................... 94
Figure 15. Sudden Unexpected Death in Infancy by Type and Month, New Zealand 2004−2008..................................................................................................................... 94
Figure 16. Sudden Unexpected Death in Infancy, South Island DHBs vs. New Zealand, 1996−2008 ...................................................................................................... 96
Figure 17. Proportion of Plunket Babies who were Exclusively or Fully Breastfed by Age, New Zealand, Years Ending June 2004−2011 ..................................................... 101
Figure 18. Proportion of Plunket Babies who were Exclusively or Fully Breastfed by Age and Ethnicity, New Zealand, Years Ending June 2004−2011 ................................ 101
Figure 19. Proportion of Plunket Babies who were Exclusively or Fully Breastfed by Age and NZ Deprivation Index Decile, New Zealand, Year Ending June 2011 ............. 102
Figure 20. Proportion of Plunket Babies who were Exclusively or Fully Breastfed by Age, South Island DHBs vs. New Zealand, Years Ending June 2004−2011 ................ 103
Figure 21. Proportion of Plunket Babies who were Exclusively or Fully Breastfed by Age and NZ Deprivation Index Decile, South Island DHBs, Year Ending June 2011 .... 104
Figure 22. Proportion of Plunket Babies who were Exclusively or Fully Breastfed at Less Than 6 Weeks by Ethnicity, South Island DHBs vs. New Zealand, Years Ending June 2004−2011 .............................................................................................. 105
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Figure 23. Proportion of Plunket Babies who were Exclusively or Fully Breastfed at 3 Months and 6 Months by Ethnicity, South Island DHBs vs. New Zealand, Years Ending June 2004−2011 .............................................................................................. 106
Figure 24. Ambulatory Sensitive Hospitalisations in Children Aged 0–4 Years, New Zealand 2000–2010 ..................................................................................................... 149
Figure 25. Ambulatory Sensitive Hospitalisations in Children Aged 0–14 Years by Age, New Zealand 2006–2010 ..................................................................................... 149
Figure 26. Ambulatory Sensitive Hospitalisations in Children Aged 0–4 Years by Ethnicity, New Zealand 2000–2010 .............................................................................. 151
Figure 27. Ambulatory Sensitive Hospitalisations in Children Aged 0–4 Years, South Island DHBs vs. New Zealand 2000–2010 ......................................................... 158
Figure 28. Ambulatory Sensitive Hospitalisations in Children Aged 0–4 Years by Ethnicity, South Island DHBs vs. New Zealand 2000–2010 ......................................... 159
Figure 29. Ambulatory Sensitive Hospitalisations in Children Aged 0–4 Years by Month, the South Island DHBs 2006–2010 .................................................................. 160
Figure 30. Acute and Arranged Hospital Admissions for Acute URTIs in Children 0−14 Years by Age, New Zealand 2006−2010 ............................................................. 177
Figure 31.Acute and Arranged Hospital Admissions for Acute URTIs in Children Aged 0–14 Years by Ethnicity, New Zealand 2000–2010 ............................................. 178
Figure 32. Acute and Arranged Hospital Admissions for Acute URTI in Children Aged 0−14 Years, South Island DHBs vs. New Zealand 2000−2010 ........................... 181
Figure 33. Acute and Arranged Hospital Admissions for Acute URTI in Children Aged 0−14 Years by Ethnicity, South Island DHBs vs. New Zealand 2000−2010 ........ 182
Figure 34. Average Number of Acute and Arranged Hospital Admissions for Acute URTI in Children Aged 0−14 Years by Month, the South Island DHBs 2006−2010 ...... 183
Figure 35. Arranged/Waiting List Admissions for Tonsillectomy +/− Adenoidectomy in Children Aged 0−14 Years, New Zealand 2000−2010 .............................................. 185
Figure 36. Arranged/Waiting List Admissions for Tonsillectomy +/− Adenoidectomy in Children 0−14 Years by Age and Ethnicity, New Zealand 2006−2010 ...................... 185
Figure 37. Arranged/Waiting List Admissions for Tonsillectomy +/− Adenoidectomy in Children Aged 0−14 Years by Ethnicity, New Zealand 2000−2010 ........................... 186
Figure 38. Arranged/Waiting List Admissions for Tonsillectomy +/− Adenoidectomy in Children Aged 0−14 Years, South Island DHBs vs. New Zealand 2000−2010 ......... 189
Figure 39. Arranged/Waiting List Admissions for Tonsillectomy +/− Adenoidectomy in Children Aged 0−14 Years by Ethnicity, South Island DHBs vs. New Zealand 2000−2010................................................................................................................... 190
Figure 40. Average Number of Arranged/Waiting List Admissions for Tonsillectomy +/− Adenoidectomy in Children 0−14 Years by Month, South Island DHBs 2006−2010................................................................................................................... 191
Figure 41. Acute Hospital Admissions for Otitis Media and Arranged/Waiting List Admissions for Grommets in Children Aged 0–14 Years, New Zealand 2000–2010 .... 200
Figure 42. Acute Hospital Admissions for Otitis Media and Arranged/Waiting List Admissions for Grommets in Children Aged 0–14 Years by Age and Ethnicity, New Zealand 2006–2010 ..................................................................................................... 200
Figure 43. Acute Hospital Admissions for Otitis Media in Children Aged 0−14 Years by Ethnicity, New Zealand 2000−2010 ......................................................................... 201
Figure 44. Arranged/Waiting List Hospital Admissions for Grommets in Children Aged 0−14 Years by Ethnicity, New Zealand 2000−2010 ............................................ 202
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Figure 45. Acute Hospital Admissions for Otitis Media and Arranged/Waiting List Admissions for Grommets in Children Aged 0−14 Years, South Island DHBs vs. New Zealand 2000−2010 ............................................................................................. 206
Figure 46. Arranged/Waiting List Hospital Admissions for Grommets in Children Aged 0−14 Years by Ethnicity, South Island DHBs vs. New Zealand 2000−2010 ........ 207
Figure 47. Average Number of Acute Hospital Admissions for Otitis Media and Arranged/ Waiting List Admissions for Grommets in Children Aged 0−14 Years by Month, the South Island DHBs 2006−2010 .................................................................. 208
Figure 48. Acute and Semi-Acute Hospital Admissions (2000–2010) and Deaths (2000–2008) from Bronchiolitis in New Zealand Infants <1 Year .................................. 218
Figure 49. Acute and Semi-Acute Hospital Admissions (2006–2010) and Deaths (2004–2008) from Bronchiolitis in New Zealand Children by Age ................................. 219
Figure 50. Acute and Semi-Acute Hospital Admissions for Bronchiolitis in Infants <1 Year by Ethnicity, New Zealand 2000–2010 ........................................................... 219
Figure 51. Acute and Semi-Acute Hospital Admissions for Bronchiolitis in Infants <1 Year, South Island DHBs vs. New Zealand 2000−2010 .......................................... 221
Figure 52. Acute and Semi-Acute Hospital Admissions for Bronchiolitis in Infants <1 Year by Ethnicity, South Island DHBs vs. New Zealand 2000−2010 ....................... 222
Figure 53. Average Number of Acute and Semi-Acute Hospital Admissions for Bronchiolitis in Infants <1 Year by Month, the South Island DHBs 2006−2010 ............. 223
Figure 54. Acute and Semi-Acute Hospital Admissions (2000–2010) and Deaths (2000−2008) from Bacterial/Non-Viral/Unspecified Pneumonia in New Zealand Children and Young People Aged 0−24 Years ............................................................. 229
Figure 55. Acute and Semi-Acute Hospital Admissions (2000−2010) and Deaths (2000–2008) from Viral Pneumonia in New Zealand Children and Young People Aged 0–24 Years ......................................................................................................... 229
Figure 56. Acute and Semi-Acute Hospital Admissions (2006–2010) and Deaths (2004−2008) from Pneumonia in New Zealand Children and Young People by Age .... 230
Figure 57. Acute and Semi-Acute Hospital Admissions for Pneumonia in Children and Young People Aged 0–24 Years by Ethnicity, New Zealand 2000–2010 ............... 230
Figure 58. Acute and Semi-Acute Hospital Admissions for Bacterial/Non-Viral/Unspecified Pneumonia in Children and Young People Aged 0−24 Years, South Island DHBs vs. New Zealand 2000−2010 ........................................................ 234
Figure 59. Acute and Semi-Acute Hospital Admissions for Viral Pneumonia in Children Aged 0−14 Years, South Island DHBs vs. New Zealand 2000−2010 ............. 235
Figure 60. Acute and Semi-Acute Hospital Admissions for Bacterial/Non-Viral/Unspecified Pneumonia in Children and Young People Aged 0−24 Years by Ethnicity, South Island DHBs vs. New Zealand 2000−2010 ......................................... 236
Figure 61. Average Number of Acute and Semi-Acute Hospital Admissions for Pneumonia in Children and Young People Aged 0−24 Years by Month, the South Island DHBs 2006−2010 .............................................................................................. 237
Figure 62. Acute and Semi-Acute Hospital Admissions (2000−2010) and Deaths (2000−2008) from Asthma in New Zealand Children and Young People Aged 0−24 Years ........................................................................................................................... 243
Figure 63. Acute and Semi-Acute Hospital Admissions (2006−2010) and Deaths (2004−2008) from Asthma in New Zealand Children and Young People by Age .......... 244
Figure 64. Acute and Semi-Acute Hospital Admissions for Asthma in Children and Young People Aged 0−24 Years by Ethnicity, New Zealand 2000−2010 ..................... 244
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Figure 65. Acute and Semi-Acute Hospital Admissions for Asthma in Children and Young People Aged 0−24 Years, South Island DHBs vs. New Zealand 2000−2010 .... 247
Figure 66. Acute and Semi-Acute Hospital Admissions for Asthma in Children and Young People 0−24 Years by Ethnicity, South Island DHBs vs. New Zealand 2000−2010................................................................................................................... 248
Figure 67. Average Number of Acute and Semi-Acute Hospital Admissions for Asthma in Children and Young People 0−24 Years by Month, the South Island DHBs 2006−2010 ........................................................................................................ 249
Figure 68. Acute and Semi-Acute Hospital Admissions (2000−2010) and Deaths (2000−2008) for New Zealand Children and Young People Aged 0−24 Years with Bronchiectasis ............................................................................................................. 256
Figure 69. Acute and Semi-Acute Hospital Admissions (2006−2010) and Deaths (2004−2008) for New Zealand Children and Young People with Bronchiectasis by Age .............................................................................................................................. 257
Figure 70. Acute and Semi-Acute Hospital Admissions for Children and Young People Aged 0−24 Years with Bronchiectasis by Ethnicity, New Zealand 2000−2010................................................................................................................... 258
Figure 71. Average Number of Acute and Semi-Acute Hospital Admissions for Children and Young People Aged 0−24 Years with Bronchiectasis by Month, New Zealand 2006−2010 ..................................................................................................... 259
Figure 72. Acute and Semi-Acute Hospital Admissions for Children and Young People Aged 0−24 Years with Bronchiectasis, South Island DHBs vs. New Zealand 2000−2010................................................................................................................... 260
Figure 73. Acute and Semi-Acute Hospital Admissions (2000−2010) and Deaths (2000−2008) from Pertussis in New Zealand Infants <1 Year ...................................... 268
Figure 74. Acute and Semi-Acute Hospital Admissions (2006−2010) and Deaths (2004−2008) from Pertussis in New Zealand Children by Age ..................................... 269
Figure 75. Acute and Semi-Acute Hospital Admissions for Pertussis in Infants <1 Year by Ethnicity, New Zealand 2000−2010 ................................................................ 269
Figure 76. Average Number of Acute and Semi-Acute Hospital Admissions for Pertussis in Infants <1 Year by Month, New Zealand 2006−2010 ................................ 270
Figure 77. Acute and Semi-Acute Hospital Admissions for Pertussis in Infants <1 Year, South Island DHBs vs. New Zealand 2000−2010 ............................................... 272
Figure 78. Acute and Semi-Acute Hospital Admissions (2000−2010) and Deaths (2000−2008) from Meningococcal Disease in New Zealand Children and Young People Aged 0−24 Years ............................................................................................. 276
Figure 79. Acute and Semi-Acute Hospital Admissions (2006−2010) and Deaths (2004−2008) from Meningococcal Disease in New Zealand Children and Young People by Age ............................................................................................................. 277
Figure 80. Acute and Semi-Acute Hospital Admissions for Meningococcal Disease in Children and Young People Aged 0−24 Years by Ethnicity, New Zealand 2000−2010................................................................................................................... 277
Figure 81. Average Number of Acute and Semi-Acute Hospital Admissions for Meningococcal Disease in Children and Young People Aged 0−24 Years by Month, New Zealand 2006−2010 ............................................................................................. 278
Figure 82. Acute and Semi-Acute Hospital Admissions for Meningococcal Disease in Children and Young People Aged 0−24 Years, South Island DHBs vs. New Zealand 2000−2010 ..................................................................................................... 280
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Figure 83. Acute and Semi-Acute Hospital Admissions (2000−2010) and Deaths (2000−2008) from Tuberculosis in New Zealand Children and Young People Aged 0−24 Years .................................................................................................................. 285
Figure 84. Acute and Semi-Acute Hospital Admissions for Tuberculosis in Children and Young People by Age, New Zealand 2006−2010 .................................................. 286
Figure 85. Acute and Semi-Acute Hospital Admissions for Tuberculosis in Children and Young People Aged 0−24 Years by Ethnicity, New Zealand 2000−2010 .............. 286
Figure 86. Average Number of Acute and Semi-Acute Hospital Admissions for Tuberculosis in Children and Young People Aged 0−24 Years by Month, New Zealand 2006−2010 ..................................................................................................... 287
Figure 87. Acute and Semi-Acute Hospital Admissions for Tuberculosis in Children and Young People Aged 0−24 Years, South Island DHBs vs. New Zealand 2000−2010................................................................................................................... 289
Figure 88. Acute and Semi-Acute Hospital Admissions (2000−2010) and Deaths (2000−2008) from Acute Rheumatic Fever and Rheumatic Heart Disease in New Zealand Children and Young People Aged 0−24 Years ............................................... 293
Figure 89. Acute and Semi-Acute Hospital Admissions (2006−2010) and Deaths (2004−2008) from Acute Rheumatic Fever and Rheumatic Heart Disease in New Zealand Children and Young People by Age ............................................................... 294
Figure 90. Acute and Semi-Acute Hospital Admissions for Acute Rheumatic Fever and Rheumatic Heart Disease in Children and Young People Aged 0–24 Years by Ethnicity, New Zealand 2000−2010 ............................................................................. 294
Figure 91. Average Number of Acute and Semi-Acute Hospital Admissions for Acute Rheumatic Fever and Rheumatic Heart Disease in Children and Young People Aged 0−24 Years by Month, New Zealand 2006−2010 .................................... 295
Figure 92. Acute and Semi-Acute Hospital Admissions for Acute Rheumatic Fever and Rheumatic Heart Disease in Children and Young People Aged 0−24 Years, South Island DHBs vs. New Zealand 2000−2010 ........................................................ 297
Figure 93. Hospital Admissions for Serious Skin Infections in Children and Young People Aged 0−24 Years, New Zealand 2000−2010 ................................................... 303
Figure 94. Hospital Admissions for Serious Skin Infections in Children and Young People Aged 0−24 Years by Age and Gender, New Zealand 2006−2010 .................... 305
Figure 95. Hospital Admissions for Serious Skin Infections in Children and Young People Aged 0−24 Years by Ethnicity, New Zealand 2000−2010 ................................ 305
Figure 96. Hospital Admissions for Serious Skin Infections in Children and Young People Aged 0−24 Years, South Island DHBs vs. New Zealand 2000−2010 ............... 314
Figure 97. Hospital Admissions for Serious Skin Infections in Children and Young People Aged 0−24 Years by Ethnicity, South Island DHBs vs. New Zealand 2000−2010................................................................................................................... 315
Figure 98. Average Number of Hospital Admissions for Serious Skin Infections in Children and Young People Aged 0−24 Years by Month, the South Island DHBs 2006−2010................................................................................................................... 316
Figure 99. Acute and Semi-Acute Hospital Admissions (2000−2010) and Deaths (2000–2008) from Gastroenteritis in New Zealand Children and Young People Aged 0–24 Years ......................................................................................................... 323
Figure 100. Acute and Semi-Acute Hospital Admissions (2006–2010) and Deaths (2004−2008) from Gastroenteritis in New Zealand Children and Young People by Age .............................................................................................................................. 323
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Figure 101. Acute and Semi-Acute Hospital Admissions for Gastroenteritis in Children and Young People Aged 0−24 Years by Ethnicity, New Zealand 2000−2010................................................................................................................... 324
Figure 102. Acute and Semi-Acute Hospital Admissions for Gastroenteritis in Children and Young People Aged 0−24 Years, South Island DHBs vs. New Zealand 2000−2010 ..................................................................................................... 326
Figure 103. Acute and Semi-Acute Hospital Admissions for Gastroenteritis in Children and Young People Aged 0−24 Years by Ethnicity, South Island DHBs vs. New Zealand 2000−2010 ............................................................................................. 327
Figure 104. Average Number of Acute and Semi-Acute Hospital Admissions for Gastroenteritis in Children and Young People Aged 0−24 Years by Month, the South Island DHBs 2006−2010 .................................................................................... 328
Figure 105. Mortality from Unintentional Injuries in Children Aged 0−14 Years by Main Underlying Cause of Death, New Zealand 2000−2008 ........................................ 338
Figure 106. Mortality from Land Transport Injuries in Children Aged 0−14 Years by Ethnicity, New Zealand 2000−2008 ............................................................................. 346
Figure 107. Average Number of Hospital Admissions for Land Transport Injuries per Month in Children Aged 0−14 Years, the South Island DHBs 2006−2010 .............. 347
Figure 108. Hospital Admissions (2006−2010) and Deaths (2004−2008) from Land Transport Injuries in New Zealand Children 0–14 Years by Age and Gender ............... 348
Figure 109. Hospital Admissions for Transport Injuries in Children 0–14 Years by Age and Injury Type, New Zealand 2006−2010 ........................................................... 348
Figure 110. Average Number of Hospital Admissions for Unintentional Non-Transport Injuries per Month in Children Aged 0−14 Years, South Island DHBs 2006−2010................................................................................................................... 353
Figure 111. Hospital Admissions (2006−2010) and Deaths (2004−2008) from Unintentional Non-Transport Injuries in New Zealand Children 0–14 Years by Age and Gender .................................................................................................................. 354
Figure 112. Hospital Admissions for Selected Unintentional Non-Transport Injuries in Children 0–14 Years by Age and Injury Type, New Zealand 2006−2010 .................. 354
Figure 113. Hospital Admissions for Falls and Mechanical Force Type Injuries in Children 0–14 Years by Age and Injury Type, New Zealand 2006−2010 ..................... 355
Figure 114. Mortality from Unintentional Non-Transport Injuries in Children Aged 0−14 Years by Ethnicity, New Zealand 2000−2008 ...................................................... 358
Figure 115. Percentage of Children Who Were Caries-Free at 5 Years and Mean DMFT Scores at 12 Years, New Zealand 2000−2010 .................................................. 364
Figure 116. Percentage of Children Who Were Caries-Free at 5 Years by Ethnicity, New Zealand 2003−2010 ............................................................................................. 364
Figure 117. Mean DMFT at 12 Years by Ethnicity, New Zealand 2003−2010 .............. 365
Figure 118. Percentage of Children Who Were Caries-Free at 5 Years, South Island DHBs vs. New Zealand 2002−2010 ................................................................... 366
Figure 119. Mean DMFT at 12 Years, South Island DHBs vs. New Zealand 2002−2009................................................................................................................... 367
Figure 120. Percentage of Children Who Were Caries-Free at 5 Years by Ethnicity, South Island DHBs with Non-Fluoridated Water Supplies vs. New Zealand 2003−2010................................................................................................................... 368
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Figure 121. Percentage of Children Who Were Caries-Free at 5 Years by Ethnicity, South Island DHBs with Fluoridated and Non-Fluoridated Water Supplies vs. New Zealand 2003−2009 ..................................................................................................... 369
Figure 122. Mean DMFT at 12 Years by Ethnicity, South Island DHBs with Non-Fluoridated Water Supplies vs. New Zealand 2003−2010 ............................................ 369
Figure 123. Mean DMFT at 12 Years by Ethnicity, South Island DHBs with Fluoridated and Non-Fluoridated Water Supplies vs. New Zealand 2003−2009 ........... 370
Figure 124. Hospital Admissions for Dental Caries in Children and Young People Aged 0−24 Years, New Zealand 2000−2010 ............................................................... 372
Figure 125. Hospital Admissions for Dental Caries in Children and Young People by Age, New Zealand 2006−2010 ................................................................................ 372
Figure 126. Hospital Admissions for Dental Caries in Children and Young People Aged 0−24 Years by Ethnicity, New Zealand 2000−2010 ............................................ 374
Figure 127. Hospital Admissions for Dental Caries in Children and Young People Aged 0−24 Years, South Island DHBs vs. New Zealand 2000−2010 ........................... 383
Figure 128. Hospital Admissions for Dental Caries in Children Aged 0−14 Years by Ethnicity, South Island DHBs vs. New Zealand 2000−2010 ......................................... 384
Figure 129. Average Number of Hospital Admissions for Dental Caries in Children and Young People Aged 0−24 Years by Month, the South Island DHBs 2006−2010 ... 385
Figure 130. Average Age of Suspicion and Confirmation of Hearing Losses, New Zealand Deafness Notification Database 2001−2005 and 2010 ................................... 394
Figure 131. Mortality from Unintentional Injuries in Young People Aged 15−24 Years by Main Underlying Cause of Death, New Zealand 2000−2008 ......................... 439
Figure 132. Average Number of Hospital Admissions for Land Transport Injuries per Month in Young People Aged 15−24 Years, South Island DHBs 2006−2010 ......... 448
Figure 133. Hospital Admissions (2006−2010) and Deaths (2004−2008) from Land Transport Injuries in New Zealand Children and Young People 0−24 Years by Age and Gender .................................................................................................................. 449
Figure 134. Hospital Admissions for Transport Injuries in Children and Young People Aged 0−24 Years by Age and Injury Type, New Zealand 2006−2010 .............. 449
Figure 135. Mortality from Land Transport Injuries in Young People Aged 15−24 Years by Ethnicity, New Zealand 2000−2008 ............................................................... 452
Figure 136. Average Number of Hospital Admissions for Unintentional Non-Transport Injuries per Month in Young People 15−24 Years, the South Island DHBs 2006−2010................................................................................................................... 454
Figure 137. Hospital Admissions (2006−2010) and Deaths (2004−2008) from Unintentional Non-Transport Injuries in New Zealand Children and Young People Aged 0−24 Years by Age and Gender ......................................................................... 455
Figure 138. Hospital Admissions for Falls and Mechanical Force Type Injuries in Children and Young People Aged 0−24 Years by Age and Injury Type, New Zealand 2006−2010 ..................................................................................................... 455
Figure 139. Mortality from Unintentional Non-Transport Injuries in Young People Aged 15−24 Years by Ethnicity, New Zealand 2000−2008........................................... 458
Figure 140. Teenage Pregnancy Rates, New Zealand 1996−2009 .............................. 462
Figure 141. Teenage Birth Rates by Ethnicity, New Zealand 2000−2010 ..................... 463
Figure 142. Live Birth Rates by Maternal Age and Ethnicity, New Zealand 2006−2010................................................................................................................... 464
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Figure 143. Teenage Birth Rates, South Island DHBs vs. New Zealand 2000−2010 ... 465
Figure 144. Teenage Birth Rates by Ethnicity, South Island DHBs vs. New Zealand 2000−2010................................................................................................................... 466
Figure 145. Terminations of Pregnancy by Age, New Zealand 1980−2010 .................. 473
Figure 146. Terminations of Pregnancy by Age, New Zealand 2010 ............................ 474
Figure 147. Terminations of Pregnancy by Age and Ethnicity, New Zealand 2010 ....... 474
Figure 148. Terminations of Pregnancy by Ethnicity in Young Women <25 Years, New Zealand 2006−2010 ............................................................................................. 475
Figure 149. Proportion of Women Who Had a Termination by Age and Gestation at Termination, New Zealand 2009 .................................................................................. 475
Figure 150. Proportion of Women Who Had a Termination by Age and Number of Previous Terminations, New Zealand 2009 .................................................................. 476
Figure 151. Gross Domestic Product (GDP): Percentage Change from Previous Quarter, New Zealand June Quarter 2007 to June Quarter 2011 ................................. 490
Figure 152. Income Inequality in New Zealand as Assessed by the P80/P20 Ratio for the 1984−2010 HES Years ..................................................................................... 493
Figure 153. Income Inequality in New Zealand as Assessed by the Gini Coefficient for the 1984−2010 HES Years ..................................................................................... 493
Figure 154. Proportion of Dependent Children Aged 0−17 Years Living Below the Income Poverty Threshold Before Housing Costs, New Zealand 1984−2010 HES Years ........................................................................................................................... 496
Figure 155. Proportion of Dependent Children Aged 0−17 Years Living Below the Income Poverty Threshold After Housing Costs, New Zealand 1984−2010 HES Years ........................................................................................................................... 496
Figure 156. Proportion of Dependent Children Living Below the 60% Income Poverty Threshold (1998 and 2007 Median, After Housing Costs) by Age, New Zealand 1984−2010 HES Years .................................................................................. 497
Figure 157. Proportion of Dependent Children Aged 0−17 Years Living Below the 60% Income Poverty Threshold (1998 and 2007 Median, After Housing Costs) by Number of Children in Household, New Zealand 1984−2010 HES Years .................... 498
Figure 158. Proportion of Dependent Children Aged 0−17 Years Living Below the 60% Income Poverty Threshold (1998 and 2007 Median, After Housing Costs) by Household Type, New Zealand 1984−2010 HES Years ............................................... 498
Figure 159. Proportion of Dependent Children Aged 0−17 Years Living Below the 60% Income Poverty Threshold (1998 and 2007 Median, After Housing Costs) by Work Status of Adults in the Household, New Zealand 1984−2010 HES Years ........... 499
Figure 160. Proportion of Children Aged 0–17 Years with Deprivation Scores of Four or More by Ethnicity and Family Income Source, NZ Living Standards Survey 2008 ............................................................................................................................ 502
Figure 161. Seasonally Adjusted Unemployment Rates, New Zealand Quarter 1 (March) 1986 to Quarter 3 (September) 2011 .............................................................. 504
Figure 162. Annual Unemployment Rates by Age (Selected Age Groups), New Zealand September 1987−2011 ................................................................................... 505
Figure 163. Annual Unemployment Rates by Age and Gender in New Zealand Young People Aged 15−24 Years, September 1987−2011 .......................................... 505
Figure 164. Quarterly Unemployment Rates by Total Response Ethnicity, New Zealand Quarter 4 (December) 2007 to Quarter 3 (September) 2011 .......................... 506
15
Figure 165. Annual Unemployment Rates by Qualification, New Zealand September 1987−2011 ................................................................................................ 507
Figure 166. Proportion of those Unemployed by Duration of Unemployment, New Zealand September 1987−September 2011 ................................................................ 507
Figure 167. Quarterly Unemployment Rates by Regional Council, South Island Regional Councils vs. New Zealand Quarter 1 (March) 2005 to Quarter 3 (September) 2011 ........................................................................................................ 508
Figure 168. Proportion of All Children Aged 0−18 Years Who Were Reliant on a Benefit or Benefit Recipient by Benefit Type, New Zealand April 2000−2011 ............... 512
Figure 169. Proportion of New Zealand Children Aged 0−18 Years Who Were Reliant on a Benefit or Benefit Recipient by Age and Benefit Type, as at the end of April 2011 .................................................................................................................... 512
Figure 170. Hospital Admissions (2000−2010) and Mortality (2000−2008) from Conditions with a Social Gradient in New Zealand Children Aged 0−14 Years (excluding Neonates) ................................................................................................... 523
Figure 171. Hospital Admissions for Conditions with a Social Gradient in Children Aged 0−14 Years by Ethnicity, New Zealand 2000−2010 ............................................ 524
Figure 172. Mortality from Conditions with a Social Gradient in Children Aged 0−14 Years (excluding Neonates) by Ethnicity, New Zealand 2000−2008 ............................ 524
Figure 173. Hospital Admissions for Conditions with a Social Gradient in Children Aged 0−14 Years by NZ Deprivation Index Decile, New Zealand 2000−2010 .............. 525
Figure 174. Mortality from Conditions with a Social Gradient in Children Aged 0−14 Years (excluding Neonates) by NZ Deprivation Index Decile, New Zealand 2000−2008................................................................................................................... 526
Figure 175. Hospital Admissions for Conditions with a Social Gradient in Children Aged 0–14 Years, South Island DHBs vs. New Zealand 2000–2010 ........................... 537
Figure 176. Hospital Admissions for Medical Conditions with a Social Gradient in Children Aged 0−14 Years by Ethnicity, the South Island DHBs vs. New Zealand 2000−2010................................................................................................................... 538
Figure 177. Hospital Admissions for Injuries with a Social Gradient in Children Aged 0−14 Years by Ethnicity, the South Island DHBs vs. New Zealand 2000−2010................................................................................................................... 539
Figure 178. Hospital Admissions (2000−2010) and Deaths (2000−2008) due to Injuries Arising from the Assault, Neglect or Maltreatment of New Zealand Children 0−14 Years .................................................................................................................. 542
Figure 179. Hospital Admissions (2006−2010) and Deaths (2004−2008) due to Injuries Arising from the Assault, Neglect or Maltreatment of New Zealand Children 0–14 Years by Age and Gender ................................................................................... 542
Figure 180. Hospital Admissions for Injuries Arising from the Assault, Neglect or Maltreatment of Children 0−14 Years by NZ Deprivation Index Decile, New Zealand 2006−2010 ..................................................................................................... 543
Figure 181. Hospital Admissions for Injuries Arising from the Assault, Neglect or Maltreatment of Children 0−14 Years by Ethnicity, New Zealand 2000−2010 .............. 543
Figure 182. Hospital Admissions for Injuries Arising from the Assault, Neglect or Maltreatment of Children Aged 0−14 Years, South Island DHBs vs. New Zealand 2000−2010................................................................................................................... 547
16
LIST OF TABLES
Table 1. Overview of the Health Status of Children and Young People in the South Island DHBs ................................................................................................................... 32
Table 2. Distribution of Live Births by Ethnicity, Nelson Marlborough, South Canterbury, and Canterbury DHBs 2000–2010 .............................................................. 50
Table 3. Distribution of Live Births by Ethnicity, West Coast, Otago and Southland DHBs 2000–2010 .......................................................................................................... 51
Table 4. Distribution of Live Births by Ethnicity, Maternal Age and NZ Deprivation Index Decile, South Island DHBs 2010 .......................................................................... 52
Table 5. Intermediate Fetal Deaths by Cause of Death, New Zealand 2004–2008 ........ 56
Table 6. Late Fetal Deaths by Cause of Death, New Zealand 2004–2008 ..................... 57
Table 7. Intermediate and Late Fetal Deaths and Unspecified Deaths by Ethnicity, NZ Deprivation Index Decile, Maternal Age and Gender, New Zealand 2004–2008 ...... 60
Table 8. Intermediate and Late Fetal Deaths, South Island DHBs vs. New Zealand 2004−2008..................................................................................................................... 61
Table 9. Intermediate and Late Fetal Deaths by Cause, Nelson Marlborough 2004−2008..................................................................................................................... 63
Table 10. Intermediate and Late Fetal Deaths by Cause, South Canterbury 2004−2008..................................................................................................................... 64
Table 11. Intermediate and Late Fetal Deaths by Cause, the West Coast 2004−2008..................................................................................................................... 64
Table 12. Intermediate and Late Fetal Deaths by Cause, Canterbury 2004−2008 ......... 65
Table 13. Intermediate and Late Fetal Deaths by Cause, Otago 2004−2008 ................. 66
Table 14. Intermediate and Late Fetal Deaths by Cause, Southland 2004−2008 ........... 67
Table 15. Local Policy Documents and Evidence-Based Reviews Relevant to the Prevention of Fetal Deaths ............................................................................................ 68
Table 16. Preterm Birth Rates in Singleton Live Born Babies, South Island DHBs vs. New Zealand 2006−2010 ......................................................................................... 74
Table 17. Preterm Birth Rates in Singleton Live Born Babies by Ethnicity, NZ Deprivation Index Decile, Gender and Maternal Age, New Zealand 2006–2010 ............ 74
Table 18. Evidence-Based Reviews Relevant to the Prevention of Spontaneous Preterm Birth ................................................................................................................. 78
Table 19. Neonatal and Post Neonatal Mortality by Main Underlying Cause of Death, New Zealand 2004−2008 ................................................................................... 85
Table 20. Risk Factors for Neonatal and Post Neonatal Mortality, New Zealand 2004−2008..................................................................................................................... 86
Table 21. Neonatal and Post Neonatal Mortality, South Island DHBs vs. New Zealand 2004−2008 ....................................................................................................... 89
Table 22. Neonatal and Post Neonatal Mortality by Main Underlying Cause of Death, Nelson Marlborough, South Canterbury and Canterbury 2004−2008.................. 90
Table 23. Neonatal and Post Neonatal Mortality by Main Underlying Cause of Death, the West Coast, Otago and Southland 2004−2008 ............................................. 91
Table 24. Risk Factors for Sudden Unexpected Death in Infancy (SUDI), New Zealand 2004−2008 ....................................................................................................... 93
17
Table 25. Sudden Unexpected Death in Infancy, South Island DHBs vs. New Zealand 2004–2008 ....................................................................................................... 95
Table 26. Local Policy Documents and Evidence-Based Reviews Relevant to SUDI Prevention ..................................................................................................................... 98
Table 27. Local Policy Documents and Evidence-Based Reviews Relevant to the Promotion or Support of Breastfeeding ........................................................................ 107
Table 28. Most Frequent Reasons for Hospital Admission in Children Aged 0–14 Years (Neonates Excluded) by Admission Type, New Zealand 2006–2010 ................. 136
Table 29. Most Frequent Causes of Mortality in Children Aged 1–14 Years by Main Underlying Cause of Death, New Zealand 2004–2008 ................................................. 137
Table 30. Most Frequent Reasons for Hospital Admission in Children Aged 0–14 Years (Neonates Excluded) by Admission Type, Nelson Marlborough 2006–2010 ...... 138
Table 31. Most Frequent Reasons for Hospital Admission in Children Aged 0–14 Years (Neonates Excluded) by Admission Type, South Canterbury 2006–2010 .......... 139
Table 32. Most Frequent Reasons for Hospital Admission in Children Aged 0–14 Years (Neonates Excluded) by Admission Type, Canterbury 2006–2010 .................... 140
Table 33. Most Frequent Reasons for Hospital Admission in Children Aged 0–14 Years (Neonates Excluded) by Admission Type, the West Coast 2006–2010 .............. 141
Table 34. Most Frequent Reasons for Hospital Admission in Children Aged 0–14 Years (Neonates Excluded) by Admission Type, Otago 2006–2010 ............................ 142
Table 35. Most Frequent Reasons for Hospital Admission in Children Aged 0–14 Years (Neonates Excluded) by Admission Type, Southland 2006–2010 ...................... 143
Table 36. Most Frequent Causes of Mortality in Children Aged 1–14 Years by Main Underlying Cause of Death, South Island DHBs 2004–2008 ........................................ 144
Table 37. Ambulatory Sensitive Hospitalisations in Children Aged 0–4 Years by Primary Diagnosis, New Zealand 2006–2010 .............................................................. 148
Table 38. Ambulatory Sensitive Hospitalisations in Children Aged 0–4 Years by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2006–2010 ............ 150
Table 39. Ambulatory Sensitive Hospitalisations in Children Aged 0–4 Years, South Island DHBs vs. New Zealand 2006–2010 ................................................................... 151
Table 40. Ambulatory Sensitive Hospitalisations in Children Aged 0–4 Years by Primary Diagnosis, Nelson Marlborough 2006–2010 ................................................... 152
Table 41. Ambulatory Sensitive Hospitalisations in Children Aged 0–4 Years by Primary Diagnosis, South Canterbury 2006–2010 ....................................................... 153
Table 42. Ambulatory Sensitive Hospitalisations in Children Aged 0–4 Years by Primary Diagnosis, Canterbury 2006–2010 .................................................................. 154
Table 43. Ambulatory Sensitive Hospitalisations in Children Aged 0–4 Years by Primary Diagnosis, the West Coast 2006–2010 ........................................................... 155
Table 44. Ambulatory Sensitive Hospitalisations in Children Aged 0–4 Years by Primary Diagnosis, Otago 2006–2010 ......................................................................... 156
Table 45. Ambulatory Sensitive Hospitalisations in Children Aged 0–4 Years by Primary Diagnosis, Southland 2006–2010 ................................................................... 157
Table 46. Local Policy Documents and Evidence-Based Reviews Which Consider Generic Approaches to Infectious and Respiratory Diseases ....................................... 166
Table 47. Local Policy Documents and Evidence-Based Reviews Relevant to the Prevention of Second Hand Cigarette Smoke Exposure .............................................. 168
18
Table 48. Local Policy Documents and Evidence-Based Reviews Relevant to Housing ....................................................................................................................... 170
Table 49. Acute and Arranged Hospital Admissions for Acute URTIs in Children Aged 0–14 Years by Primary Diagnosis, New Zealand 2006–2010 ............................. 177
Table 50. Acute and Arranged Hospital Admissions for Acute URTIs in Children Aged 0–14 Years by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2006–2010 ..................................................................................................... 178
Table 51. Acute and Arranged Hospital Admissions for Acute URTI in Children Aged 0–14 Years by Primary Diagnosis, Nelson Marlborough, South Canterbury, Canterbury and the West Coast 2006–2010 ................................................................ 179
Table 52. Acute and Arranged Hospital Admissions for Acute URTI in Children Aged 0–14 Years by Primary Diagnosis, Otago and Southland 2006–2010 ................. 180
Table 53. Acute and Arranged Hospital Admissions for Acute URTI in Children Aged 0–14 Years, South Island DHBs vs. New Zealand 2006–2010 ........................... 180
Table 54. Arranged/Waiting List Admissions for Tonsillectomy +/− Adenoidectomy in Children Aged 0−14 Years by Primary Diagnosis, New Zealand 2006−2010 ........... 184
Table 55. Arranged/Waiting List Admissions for Tonsillectomy +/− Adenoidectomy in Children Aged 0−14 Years by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2006−2010 ............................................................................... 186
Table 56. Arranged/Waiting List Admissions for Tonsillectomy +/− Adenoidectomy in Children Aged 0−14 Years, South Island DHBs vs. New Zealand 2006−2010 ......... 187
Table 57. Arranged/Waiting List Admissions for Tonsillectomy +/− Adenoidectomy in Children Aged 0−14 Years by Primary Diagnosis, South Island DHBs 2006−2010 .. 188
Table 58. Local Policy Documents and Evidence-Based Reviews Relevant to the Prevention and Management of Upper Respiratory Tract Infections and Tonsillectomy ............................................................................................................... 193
Table 59. Acute Hospital Admissions for Conditions of the Middle Ear and Mastoid in Children Aged 0–14 Years by Primary Diagnosis, New Zealand 2006–2010 ........... 199
Table 60. Arranged/Waiting List Hospital Admissions for Grommets in Children Aged 0–14 Years by Primary Diagnosis, New Zealand 2006–2010 ............................. 199
Table 61. Acute Hospital Admissions for Otitis Media in Children Aged 0−14 Years by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2006−2010 ....... 201
Table 62. Arranged/Waiting List Admissions for Grommets in Children Aged 0−14 Years by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2006−2010................................................................................................................... 202
Table 63. Acute Hospital Admissions for Otitis Media and Arranged/Waiting List Admissions for Grommets in Children Aged 0−14 Years, South Island DHBs vs. New Zealand 2006−2010 ............................................................................................. 203
Table 64. Acute Hospital Admissions for Conditions of the Middle Ear and Mastoid in Children Aged 0−14 Years by Primary Diagnosis, South Island DHBs 2006−2010 .. 204
Table 65. Arranged/Waiting List Hospital Admissions for Grommets in Children Aged 0−14 Years by Primary Diagnosis, South Island DHBs 2006−2010 .................... 205
Table 66. Local Policy Documents and Evidence-Based Reviews Relevant to the Identification of Acquired Hearing Losses, or the Management of Otitis Media (including Grommets) ................................................................................................... 210
Table 67. Acute and Semi-Acute Hospital Admissions for Bronchiolitis in Infants <1 Year by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2006–2010 ............................................................................................................................ 220
19
Table 68. Acute and Semi-Acute Hospital Admissions for Bronchiolitis in Infants <1 Year, South Island DHBs vs. New Zealand 2006−2010 ............................................... 220
Table 69. Policy Documents and Evidence-Based Reviews Relevant to the Prevention and Management of Bronchiolitis ............................................................... 225
Table 70. Acute and Semi-Acute Hospital Admissions for Bacterial/Non-Viral/Unspecified Pneumonia in Children and Young People Aged 0–24 Years by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2006–2010 ............ 231
Table 71. Acute and Semi-Acute Hospital Admissions for Viral Pneumonia in Children and Young People Aged 0−14 Years by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2006−2010 ............................................................. 232
Table 72. Acute and Semi-Acute Hospital Admissions for Pneumonia in Children and Young People Aged 0−24 Years, South Island DHBs vs. New Zealand 2006−2010................................................................................................................... 233
Table 73. Local Policy Documents and Evidence-Based Reviews Relevant to the Prevention and Management of Pneumonia ................................................................ 239
Table 74. Acute and Semi-Acute Hospital Admissions for Asthma in Children and Young People Aged 0−24 Years by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2006−2010 ............................................................................... 245
Table 75. Acute and Semi-Acute Hospital Admissions for Asthma in Children and Young People Aged 0−24 Years, South Island DHBs vs. New Zealand 2006−2010 .... 246
Table 76. Local Policy Documents and Evidence-Based Reviews Relevant to the Prevention and Management of Asthma in Children and Young People ...................... 251
Table 77. Acute and Semi-Acute Hospital Admissions for Children and Young People Aged 0−24 Years with Bronchiectasis by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2006−2010 ............................................................. 258
Table 78. Acute and Semi-Acute Hospital Admissions for Children and Young People Aged 0−24 Years with Bronchiectasis, South Island DHBs vs. New Zealand 2006−2010................................................................................................................... 259
Table 79. Evidence-Based Reviews Relevant to the Prevention and Management of Bronchiectasis ......................................................................................................... 262
Table 80. Acute and Semi-Acute Hospital Admissions for Pertussis in Infants <1 Year by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2006−2010................................................................................................................... 270
Table 81. Acute and Semi-Acute Hospital Admissions for Pertussis in Infants <1 Year, South Island DHBs vs. New Zealand 2006−2010 ............................................... 271
Table 82. Local Policy Documents and Evidence-Based Reviews Relevant to the Prevention of Pertussis ................................................................................................ 273
Table 83. Acute and Semi-Acute Hospital Admissions for Meningococcal Disease in Children and Young People Aged 0−24 Years by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2006−2010 ............................................................. 278
Table 84. Acute and Semi-Acute Hospital Admissions for Meningococcal Disease in Children and Young People 0−24 Years, South Island DHBs vs. New Zealand 2006−2010................................................................................................................... 279
Table 85. Local Policy Documents and Evidence-Based Reviews Relevant to the Prevention and Management of Meningococcal Disease ............................................. 281
Table 86. Acute and Semi-Acute Hospital Admissions for Tuberculosis in Children and Young People Aged 0−24 Years by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2006−2010 ............................................................................... 287
20
Table 87. Acute and Semi-Acute Hospital Admissions for Tuberculosis in Children and Young People Aged 0−24 Years, South Island DHBs vs. New Zealand 2006−2010................................................................................................................... 288
Table 88. Local Policy Documents and Evidence-Based Reviews Relevant to the Control of Tuberculosis ................................................................................................ 290
Table 89. Acute and Semi-Acute Hospital Admissions for Acute Rheumatic Fever and Rheumatic Heart Disease in Children and Young People Aged 0−24 Years by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2006−2010 ............ 295
Table 90. Acute and Semi-Acute Hospital Admissions for Acute Rheumatic Fever and Rheumatic Heart Disease in Children and Young People Aged 0–24 Years, South Island DHBs vs. New Zealand 2006–2010 ......................................................... 296
Table 91. Local Guidelines and Evidence-Based Reviews Relevant to the Prevention and Management of Acute Rheumatic Fever and Rheumatic Heart Disease........................................................................................................................ 299
Table 92. Hospital Admissions for Serious Skin Infections in Children and Young People Aged 0−24 Years by Primary Diagnosis, New Zealand 2006−2010 ................. 304
Table 93. Hospital Admissions for Serious Skin Infections in Children and Young People Aged 0−24 Years by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2006−2010 ............................................................................................. 306
Table 94. Hospital Admissions for Serious Skin Infections in Children and Young People Aged 0−24 Years by Primary Diagnosis, Nelson Marlborough 2006−2010 ...... 307
Table 95. Hospital Admissions for Serious Skin Infections in Children and Young People Aged 0−24 Years by Primary Diagnosis, South Canterbury 2006−2010 .......... 308
Table 96. Hospital Admissions for Serious Skin Infections in Children and Young People Aged 0−24 Years by Primary Diagnosis, Canterbury 2006−2010..................... 309
Table 97. Hospital Admissions for Serious Skin Infections in Children and Young People Aged 0−24 Years by Primary Diagnosis, the West Coast 2006−2010 .............. 310
Table 98. Hospital Admissions for Serious Skin Infections in Children and Young People Aged 0−24 Years by Primary Diagnosis, Otago 2006−2010 ............................ 311
Table 99. Hospital Admissions for Serious Skin Infections in Children and Young People Aged 0−24 Years by Primary Diagnosis, Southland 2006−2010 ...................... 312
Table 100. Hospital Admissions for Serious Skin Infections in Children and Young People Aged 0−24 Years, South Island DHBs vs. New Zealand 2006−2010 ............... 313
Table 101. Local Policy Documents and Evidence-Based Reviews Relevant to the Prevention or Management of Serious Skin Infections ................................................. 318
Table 102. Acute and Semi-Acute Hospital Admissions for Gastroenteritis in Children Aged 0−14 Years by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2006−2010 ............................................................................................. 324
Table 103. Acute and Semi-Acute Hospital Admissions for Gastroenteritis in Young People Aged 15−24 Years by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2006−2010 ............................................................................................. 325
Table 104. Acute and Semi-Acute Hospital Admissions for Gastroenteritis in Children and Young People Aged 0−24 Years, South Island DHBs vs. New Zealand 2006−2010 ..................................................................................................... 325
Table 105. Local Policy Documents and Evidence-Based Reviews Relevant to the Prevention and Management of Gastroenteritis ........................................................... 330
Table 106. Hospital Admissions (2006−2010) and Mortality (2004−2008) from Injuries in New Zealand Children Aged 0−14 Years by Main External Cause of Injury ............................................................................................................................ 339
21
Table 107. Hospital Admissions (2006−2010) and Mortality (2004−2008) from Injuries in Nelson Marlborough Children Aged 0−14 Years by Main External Cause of Injury ........................................................................................................................ 340
Table 108. Hospital Admissions (2006−2010) and Mortality (2004−2008) from Injuries in South Canterbury Children Aged 0−14 Years by Main External Cause of Injury ............................................................................................................................ 341
Table 109. Hospital Admissions (2006−2010) and Mortality (2004−2008) from Injuries in Canterbury Children Aged 0−14 Years by Main External Cause of Injury .... 342
Table 110. Hospital Admissions (2006−2010) and Mortality (2004−2008) from Injuries in West Coast Children Aged 0−14 Years by Main External Cause of Injury .... 343
Table 111. Hospital Admissions (2006−2010) and Mortality (2004−2008) from Injuries in Otago Children Aged 0−14 Years by Main External Cause of Injury ............ 344
Table 112. Hospital Admissions (2006−2010) and Mortality (2004−2008) from Injuries in Southland Children Aged 0−14 Years by Main External Cause of Injury ...... 345
Table 113. Hospital Admissions (2006−2010) and Mortality (2004−2008) from Land Transport Injuries in Children Aged 0−14 Years, South Island DHBs vs. New Zealand........................................................................................................................ 346
Table 114. Hospital Admissions for Pedestrian Injuries in Children Aged 0−14 Years by Gender, Ethnicity and NZ Deprivation Index Decile, New Zealand 2006−2010................................................................................................................... 349
Table 115. Hospital Admissions for Cyclist and Motorbike Injuries in Children Aged 0−14 Years by Gender, Ethnicity and NZ Deprivation Index Decile, New Zealand 2006−2010................................................................................................................... 350
Table 116. Hospital Admissions for Vehicle Occupant Injuries in Children 0−14 Years by Gender, Ethnicity and NZ Deprivation Index Decile, New Zealand 2006−2010................................................................................................................... 351
Table 117. Hospital Admissions (2006−2010) and Mortality (2004−2008) from Unintentional Non-Transport Injuries in Children Aged 0−14 Years, South Island DHBs vs. New Zealand ................................................................................................ 351
Table 118. Hospital Admissions for Accidental Poisoning in Children Aged 0−14 Years by Gender, Ethnicity and NZ Deprivation Index Decile, New Zealand 2006−2010................................................................................................................... 355
Table 119. Hospital Admissions for Falls and Electricity/Fire/Burn Injuires in Children Aged 0−14 Years by Gender, Ethnicity and NZ Deprivation Index Decile, New Zealand 2006−2010 ............................................................................................. 356
Table 120. Hospital Admissions for Injuries Arising from Inanimate and Animate Mechanical Forces in Children Aged 0−14 Years by Gender, Ethnicity and NZ Deprivation Index Decile, New Zealand 2006−2010 ..................................................... 357
Table 121. Local Policy Documents and Evidence-Based Reviews Relevant to the Prevention of Unintentional Injuries in Children ............................................................ 359
Table 122. Proportion of Adolescents Using Publicly Funded Dental Services, South Island DHBs vs. New Zealand 2004−2009 ........................................................ 370
Table 123. Hospital Admissions for Dental Conditions in Children and Young People Aged 0−24 Years by Primary Diagnosis, New Zealand 2006−2010 ................. 373
Table 124. Hospital Admissions for Dental Caries in Children Aged 0−4 Years by Gender, Ethnicity and NZ Deprivation Index Decile, New Zealand 2006−2010 ............ 374
Table 125. Hospital Admissions for Dental Caries in Children and Young People Aged 5−24 Years by Gender, Ethnicity and NZ Deprivation Index Decile, New Zealand 2006−2010 ..................................................................................................... 375
22
Table 126. Hospital Admissions for Dental Conditions in Children and Young People Aged 0−24 Years, Nelson Marlborough 2006−2010......................................... 376
Table 127. Hospital Admissions for Dental Conditions in Children and Young People Aged 0−24 Years, South Canterbury 2006−2010 ............................................. 377
Table 128. Hospital Admissions for Dental Conditions in Children and Young People Aged 0−24 Years, Canterbury 2006−2010 ....................................................... 378
Table 129. Hospital Admissions for Dental Conditions in Children and Young People Aged 0−24 Years, West Coast 2006−2010 ...................................................... 379
Table 130. Hospital Admissions for Dental Conditions in Children and Young People Aged 0−24 Years, Otago 2006−2010 ............................................................... 380
Table 131. Hospital Admissions for Dental Conditions in Children and Young People Aged 0−24 Years, Southland 2006−2010 ........................................................ 381
Table 132. Hospital Admissions for Dental Caries in Children and Young People Aged 0−24 Years, South Island DHBs vs. New Zealand 2006−2010 ........................... 382
Table 133. Local Policy Documents and Evidence-Based Reviews Relevant to Oral Health Issues in Children and Young People ............................................................... 387
Table 134. Deafness Notification Database Notifications by Type of Hearing Loss, New Zealand 2000−2005 and 2010 ............................................................................. 393
Table 135. Notifications to Deafness Notification Database by Degree of Hearing Loss Using Old Criteria, New Zealand 2001−2004 and 2010 ....................................... 394
Table 136. Number of Notifications Meeting the Old Criteria for Inclusion in Deafness Notification Database by Region of Residence, New Zealand 1998−2004 ... 395
Table 137. Number of Notifications Meeting New Criteria for Deafness Notification Database by District Health Board, New Zealand 2010 ................................................ 396
Table 138. Newborn Hearing Screening Indicators by District Health Board, New Zealand 1 April 2010 to 30 September 2010 ................................................................ 398
Table 139. Newborn Hearing Screening Indicators by Ethnicity, NZ Deprivation Index Decile and Birth Location, New Zealand 1 April 2010 to 30 September 2010 ..... 399
Table 140. Policy Documents and Evidence-Based Reviews Relevant to the Early Detection and Management of Permanent Hearing Loss in Children and Young People ......................................................................................................................... 400
Table 141. Developmental Tasks of Adolescence ........................................................ 409
Table 142. Most Frequent Causes of Mortality in Young People Aged 15−24 Years by Main Underlying Cause of Death, New Zealand 2004−2008 ................................... 427
Table 143. Most Frequent Reasons for Hospital Admission in Young People Aged 15−24 Years by Admission Type, New Zealand 2006−2010 ........................................ 428
Table 144. Most Frequent Causes of Mortality in Young People Aged 15−24 Years by Main Underlying Cause of Death, Nelson Marlborough, South Canterbury and Canterbury 2004−2008 ................................................................................................ 429
Table 145. Most Frequent Causes of Mortality in Young People Aged 15−24 Years by Main Underlying Cause of Death, West Coast, Otago and Southland 2004−2008 .. 430
Table 146. Most Frequent Reasons for Hospital Admission in Young People Aged 15−24 Years by Admission Type, Nelson Marlborough 2006−2010 ............................. 431
Table 147. Most Frequent Reasons for Hospital Admission in Young People Aged 15−24 Years by Admission Type, South Canterbury 2006−2010 ................................. 432
Table 148. Most Frequent Reasons for Hospital Admission in Young People Aged 15−24 Years by Admission Type, Canterbury 2006−2010 ........................................... 433
23
Table 149. Most Frequent Reasons for Hospital Admission in Young People Aged 15−24 Years by Admission Type, West Coast 2006−2010........................................... 434
Table 150. Most Frequent Reasons for Hospital Admission in Young People Aged 15−24 Years by Admission Type, Otago 2006−2010 ................................................... 435
Table 151. Most Frequent Reasons for Hospital Admission in Young People Aged 15−24 Years by Admission Type, Southland 2006−2010 ............................................. 436
Table 152. Hospital Admissions (2006−2010) and Mortality (2004−2008) from Injuries in New Zealand Young People Aged 15–24 Years by Cause .......................... 440
Table 153. Hospital Admissions (2006−2010) and Mortality (2004−2008) from Injuries in Nelson Marlborough Young People Aged 15−24 Years by Cause ............... 441
Table 154. Hospital Admissions (2006–2010) and Mortality (2004−2008) from Injuries in South Canterbury Young People Aged 15−24 Years by Cause ................... 442
Table 155. Hospital Admissions (2006–2010) and Mortality (2004−2008) from Injuries in Canterbury Young People Aged 15−24 Years by Cause ............................. 443
Table 156. Hospital Admissions (2006−2010) and Mortality (2004−2008) from Injuries in West Coast Young People Aged 15−24 Years by Cause ............................. 444
Table 157. Hospital Admissions (2006–2010) and Mortality (2004−2008) from Injuries in Otago Young People Aged 15−24 Years by Cause ..................................... 445
Table 158. Hospital Admissions (2006−2010) and Mortality (2004−2008) from Injuries in Southland Young People Aged 15−24 Years by Cause ............................... 446
Table 159. Hospital Admissions (2006−2010) and Mortality (2004−2008) from Land Transport Injuries in Young People 15−24 Years, South Island DHBs, vs. New Zealand........................................................................................................................ 447
Table 160. Hospital Admissions for Pedestrian and Cyclist Injuries in Young People 15−24 Years by Gender, Ethnicity and NZ Deprivation Index Decile, New Zealand 2006−2010................................................................................................................... 450
Table 161. Hospital Admissions for Motorbike and Vehicle Occupant Injuries in Young People Aged 15−24 Years by Gender, Ethnicity and NZ Deprivation Index Decile, New Zealand 2006−2010 ................................................................................. 451
Table 162. Hospital Admissions (2006−2010) and Mortality (2004−2008) from Unintentional Non-Transport Injuries in the South Island DHBs Young People Aged 15−24 Years, vs. New Zealand .................................................................................... 453
Table 163. Hospital Admissions for Falls and Electricity/Fire/Burn Injuires in Young People 15−24 Years by Gender, Ethnicity and NZ Deprivation Index Decile, New Zealand 2006−2010 ..................................................................................................... 456
Table 164. Hospital Admissions for Injuries Arising from Inanimate and Animate Mechanical Forces in Young People Aged 15−24 Years by Gender, Ethnicity and NZ Deprivation Index Decile, New Zealand 2006−2010 ............................................... 457
Table 165. Local Policy Documents and Evidence-Based Reviews Relevant to the Prevention Unintentional Injuries in Young People ....................................................... 459
Table 166. Teenage Birth Rates by Ethnicity and NZ Deprivation Index Decile, New Zealand 2006−2010 ..................................................................................................... 463
Table 167. Teenage Birth Rates, South Island DHBs vs. New Zealand 2006−2010 ..... 464
Table 168. Local Policy Documents and Evidence-Based Reviews Relevant to the Support of Teenage Parents ........................................................................................ 467
Table 169. Terminations of Pregnancy by Regional Council of Residence, New Zealand 2004−2009 ..................................................................................................... 476
24
Table 170. Terminations of Pregnancy by Healthcare Facility, New Zealand 2003−2009................................................................................................................... 477
Table 171. Local Policy Documents and Evidence-Based Reviews Relevant to Unintentional Pregnancies in Adolescents ................................................................... 478
Table 172. Restrictions Experienced by Children, by the Deprivation Score of their Family, NZ Living Standards Survey 2008 ................................................................... 501
Table 173. Number of Children Aged 0−18 Years Who Were Reliant on a Benefit or Benefit Recipient by Benefit Type, New Zealand April 2000−2011 .......................... 513
Table 174. Number of Children Aged 0−18 Years Who Were Reliant on a Benefit or Benefit Recipient by Benefit Type for Service Centres in the Nelson Marlborough, South Canterbury, Canterbury, and West Coast DHB Catchments, April 2007−2011 .......................................................................................................... 514
Table 175. Number of Children Aged 0−18 Years Who Were Reliant on a Benefit or Benefit Recipient by Benefit Type for Service Centres in the Otago and Southland DHB Catchments, April 2007−2011 ............................................................ 515
Table 176. Hospital Admissions for Conditions with a Social Gradient in Children Aged 0−14 Years (excluding Neonates) by Primary Diagnosis, New Zealand 2006−2010................................................................................................................... 521
Table 177. Mortality from Conditions with a Social Gradient in Children Aged 0−14 Years (excluding Neonates) by Main Underlying Cause of Death, New Zealand 2004−2008................................................................................................................... 522
Table 178. Risk Factors for Hospital Admissions with a Social Gradient in Children Aged 0−14 Years, New Zealand 2006−2010 ............................................................... 527
Table 179. Risk Factors for Mortality with a Social Gradient in Children Aged 0−14 Years, New Zealand 2004−2008 .................................................................................. 528
Table 180. Hospital Admissions for Conditions with a Social Gradient in Children Aged 0−14 Years, South Island DHBs vs. New Zealand 2006−2010 ........................... 529
Table 181. Hospital Admissions for Conditions with a Social Gradient in Children Aged 0−14 Years by Primary Diagnosis, Nelson Marlborough 2006−2010 .................. 530
Table 182. Hospital Admissions for Conditions with a Social Gradient in Children Aged 0−14 Years by Primary Diagnosis, South Canterbury 2006−2010 ...................... 531
Table 183. Hospital Admissions for Conditions with a Social Gradient in Children Aged 0−14 Years by Primary Diagnosis, Canterbury 2006−2010 ................................ 532
Table 184. Hospital Admissions for Conditions with a Social Gradient in Children Aged 0−14 Years by Primary Diagnosis, the West Coast 2006−2010 .......................... 533
Table 185. Hospital Admissions for Conditions with a Social Gradient in Children Aged 0−14 Years by Primary Diagnosis, Otago 2006−2010 ........................................ 534
Table 186. Hospital Admissions for Conditions with a Social Gradient in Children Aged 0−14 Years by Primary Diagnosis, Southland 2006−2010 .................................. 535
Table 187. Mortality from Conditions with a Social Gradient in Children Aged 0–14 Years (excluding Neonates) by Main Underlying Cause of Death, the South Island DHBs 2004−2008 ........................................................................................................ 536
Table 188. Hospital Admissions for Injuries Arising from the Assault, Neglect or Maltreatment of Children 0−14 Years by Ethnicity, NZ Deprivation Index Decile and Gender, New Zealand 2006−2010 ............................................................................... 544
Table 189. Nature of Injury Arising from Assault, Neglect or Maltreatment in Hospitalised Children 0−12 Years by Age Group, New Zealand 2006−2010 ................ 545
25
Table 190. Hospital Admissions for Injuries Arising from the Assault, Neglect, or Maltreatment of Children 0−14 Years, South Island DHBs vs. New Zealand 2006−2010................................................................................................................... 546
Table 191. New Paediatric ASH Codes Developed for the New Zealand Health Sector .......................................................................................................................... 567
Table 192. Weightings Applied to Potentially Avoidable Hospital Admissions by Jackson and Tobias [101] and Subsequently Used by the New Zealand Ministry of Health [299] ................................................................................................................. 568
26
27
INTRODUCTION AND OVERVIEW
28
Introduction and Overview - 29
INTRODUCTION AND OVERVIEW
Introduction
This report is the first of three reports, on the health of children and young people in the South Island, and fits into the reporting cycle as follows:
Year 1 (2011) Health Outcomes
Year 2 (2012) Health Determinants
Year 3 (2013) Disability and Chronic Conditions
While the aim of the two previous reporting cycles was to present an overview of the major issues affecting the health of children and young people in the South Island DHBs individually, this third series, while building on the frameworks developed in the previous two, aims to take a more regional approach to child and youth health needs assessment.
Report Aims and In-Depth Topics The aim of the current report is to provide an overview of the health status of children and young people in the South Island, and to assist those working to improve child and youth health regionally, to utilise all of the available evidence when developing programmes and interventions to address child and youth health need.
In this context, the role primary care plays in preventing a range of avoidable hospital admissions and mortality is crucial, with this year’s in depth topics focusing on the role of primary care in achieving health gains for children and young people. Specifically, the issues considered in this year’s in-depth topics are:
1. Models of Primary Care for Children: This in-depth topic focuses on ambulatory sensitive hospitalisations (ASH) in children, particularly those under 5 years of age. A factor common to many of these admissions is the abrupt nature of their onset. The reasons why primary care may not be addressing these acute conditions and the role of primary care in the management of chronic conditions are examined. The international literature also identifies a number of barriers to optimal service delivery that may impact at the personal or organisational level. Models that attempt to reduce such barriers by improving access, ensuring cultural and language appropriateness, and providing adequate out-of-hours services have been effective in improving services or reducing avoidable hospitalisations. Other models have focused on developing nurse-led services, or better information sharing systems within and between sectors of the health system. The literature also includes funding models that have achieved health gains. How these models could assist with the delivery of more effective primary health care to New Zealand children is discussed.
2. Models of Primary Care for Young People: This in-depth topic begins with a brief overview of the health issues most commonly encountered by New Zealand young people, before exploring the normal developmental milestones which occur during adolescence, and the implications these have for the delivery of primary healthcare. The three most frequent models of primary healthcare available to young people are then reviewed, namely: General Practitioners/Primary Health Organisations, School Based Health Services and Youth One Stop Shops. For each model of care, a brief description of the degree to which it has been implemented in the New Zealand context is provided, before the findings of any local evaluations are reviewed. Each section concludes with a brief review of the overseas literature, which seeks to identify evidence of effective service delivery, or guidance as to how optimal services might be developed. The review concludes with a brief discussion of the implications of these findings for the delivery of primary healthcare to young people in New Zealand.
Introduction and Overview - 30
Report Sections and Indicators As previously, this report is based on the Indicator Framework developed during the first cycle of DHB reporting, with the majority of indicators in the Individual and Whanau Health and Wellbeing stream being updated in this year’s edition. Within this stream, each of the indicators in this year’s report has been assigned to one of three main sections as follows:
Issues More Common in Infancy: This section considers issues more common during the first year of life, and includes indicators such as Fetal Deaths, Preterm Birth, Infant Mortality and Sudden Unexpected Death in Infancy (SUDI), and Breastfeeding.
Issues More Common in Children, or Common in both Children and Young People: This section, which focuses on issues more common to children or to both children and young people, is further subdivided into three sub-sections: Total and Avoidable Morbidity and Mortality, Infectious and Respiratory Diseases (including Upper and Lower Respiratory Tract Conditions and Infectious Diseases) and Other Issues (including Injuries in Children, Oral Health and Permanent Hearing Loss).
Issues More Common in Young People: This stream reviews a number of conditions more common in young people including The Most Frequent Causes of Hospital Admissions and Mortality, Injuries, Teenage Births and Terminations of Pregnancy.
The Children’s Social Health Monitor The Children’s Social Health Monitor is updated again in this year’s report, with a view to determining how children are faring in the current economic climate. Issues reviewed include: Economic Indicators: GDP, Income Inequality, Child Poverty, Unemployment Rates and Number of Children Reliant on Benefit Recipients; and Child Wellbeing Indicators: Hospital Admissions and Mortality with a Social Gradient, Infant Mortality, and Hospital Admissions for Injuries Arising from Assault in Children.
Evidence-Based Approaches to Intervention As previously, each of the sections in this year’s report concludes with a brief overview of local policy documents and evidence-based reviews which consider population level approaches to the prevention or management of the issue under review. Appendix 1 provides an overview of the methodology used to develop these reviews. As previously, the quality and depth of evidence available varies considerably from indicator to indicator.
Data Quality Issues and the Signalling of Statistical Significance For a number of conditions in this report, hospital admission rates for South Island Māori and European children appear much more similar than in other parts of New Zealand. While this may potentially suggest that disparities between Māori and European children are less in the South Island than elsewhere, it may also potentially signal an issue with the quality of the ethnicity data in the National Minimum Dataset. Caution is thus urged when interpreting the local ethnic specific rates presented in this report, as there is a real possibility that Māori children are being undercounted in the figures presented.
As previously Appendix 2 outlines the rationale for the use of statistical significance testing in this report and Appendix 4 to Appendix 9 contain information on the data sources used to develop each indicator. Readers are urged to be aware of the contents of these Appendices when interpreting any information in this report. (Note: As outlined in Appendix 2, in order to assist the reader to determine whether tests of statistical significance have been used in a particular section, the significance of the associations presented has been signalled in the text with the words significant, or not significant in italics. Where the words significant or not significant do not appear in the text, then the associations described do not imply statistical significance or non-significance).
Overview of the Health Status of Children and Young People in the South Island
While it is hoped that a regional approach will serve to enhance the utility of this report for regional planning purposes, the need for a consistent approach to monitoring over time means that the way the data are presented is very similar to previous years. Thus the table
Introduction and Overview - 31
which follows provides a brief overview of each of the indicators in this year’s report, including their distribution nationally and within the South Island DHBs.
While it is possible to consider each of these issues individually, when considering which should be awarded the highest priority in future regional planning, a number of the approaches to prioritising health need outlined below may provide useful starting points:
Regional Comparative Approach: One possible approach to prioritising health need is to consider those areas where the South Island DHBs differ from the New Zealand average. A brief perusal of the tables which follow however, suggests for many conditions (e.g. hospitalisations for bronchiolitis in infants, and pneumonia, asthma and skin infections in children) rates in the South Island DHBs are significantly lower than the New Zealand rate. Similarly ambulatory sensitive hospitalisations and admissions for gastroenteritis in children were also significantly lower than the New Zealand rate in all South Island DHBs except Southland, where rates were significantly higher. Hospital admissions for land transport injuries in children however, were significantly higher than the New Zealand rate in all South Island DHBs except Canterbury, while admissions for young people were significantly higher in all South Island DHBs except Canterbury and Otago.
An Inequalities Approach: An alternative approach to prioritisation would be to consider those issues for which ethnic or socioeconomic disparities were most marked. A brief review of the tables which follow however, suggests that differences between Māori and European children and young people in hospital admissions for many conditions were not marked. While this may potentially indicate smaller regional ethnic disparities, it may also signal that Māori children and young people are being undercounted in local hospital admission data, and this should be taken into account when interpreting the ethnic specific data presented in this report.
An Absolute Approach: Another approach to prioritisation is to consider those issues which, irrespective of regional or ethnic inequalities, made the greatest contributions to hospital admissions and mortality in the region. A brief perusal of the tables which follow suggests that in the South Island DHBs during the past 5 years, injuries (particularly from land transport injuries) and neoplasms were common causes of mortality for children and young people. Suicide, however, also claimed the lives of a large number of young people. In terms of hospital admissions, injuries again made a significant contribution to morbidity for both children and young people, although infectious and respiratory conditions were prominent for children, and reproductive health issues (particularly admissions for labour and delivery) were important for young people.
Consideration of Areas of Unmet Need: Finally, it is important to remember that hospital admission and mortality data does not fully capture all of the issues experienced by children and young people. In particular, there is a paucity of information on children and young people with disabilities and mental health issues, with the 2009 and 2010 reports suggesting that there may be considerable unmet need in these areas. Thus, in addition to the approaches outlined above, it is also necessary to consider whether similar areas of unmet need exist in the South Island DHBs, and if so, to consider the needs of these children and young people when allocating resources for future service development.
Conclusions In addition to providing an overview of the health status of children and young people in the South Island, this report aims to provide an entry point into the policy and evidence-based review literatures, so that child and youth health needs can be addressed in a systematic and evidence-based manner. In undertaking this task, it is suggested that DHBs combine the epidemiological data in this report, with knowledge of existing services and local stakeholders’ views. In addition, any approaches developed need to be congruent with current Ministry of Health policy, and the evidence contained in the current literature. Finally, for those developing new approaches in areas where there is currently no sound evidence base, the plea is that they build into their programmes an evaluation arm, so that learning gained can be used by others to enhance the wellbeing of children and young people and to ensure the best use of available resources.
Intr
odu
ctio
n a
nd
Ove
rvie
w -
32
Table
1. O
verv
iew
of
the H
ealth S
tatu
s o
f C
hild
ren a
nd Y
oung P
eople
in t
he S
outh
Isla
nd D
HB
s
Ind
ica
tor
New
Ze
ala
nd
Dis
trib
utio
n a
nd
Tre
nd
s
So
uth
Isla
nd
Dis
trib
utio
n a
nd
Tre
nd
s
Issue
s M
ore
Co
mm
on in
In
fancy
Reg
iona
l B
irth
s
In
Ne
w
Ze
ala
nd
, 4
6.4
%
of
ne
wb
orn
b
ab
ies
reg
iste
red
du
rin
g
201
0
we
re
Eu
rop
ean
, 2
9.2
% w
ere
M
āo
ri,
11.5
% w
ere
A
sia
n/In
dia
n,
an
d 1
1.2
% w
ere
P
acific
. W
hile
7.0
1%
we
re b
orn
to m
oth
ers
ag
ed
<2
0 y
ea
rs,
29
.1%
we
re b
orn
to
m
oth
ers
a
ge
d
35
+
ye
ars
. In
a
dd
itio
n,
15.0
%
we
re
bo
rn
into
th
e
lea
st
de
pri
ve
d (N
ZD
ep
d
ecile
1
–2
) a
rea
s,
wh
ile 2
7.1
% w
ere
b
orn
in
to th
e m
ost
de
pri
ve
d (
NZ
De
p d
ecile
9–
10
) a
rea
s.
In t
he
So
uth
Isla
nd
du
rin
g 2
00
0–
20
10
, th
e n
um
be
r of
live
bir
ths r
eg
iste
red
an
nu
ally
va
ried
, w
ith
num
be
rs i
ncre
asin
g i
n N
els
on
Ma
rlb
oro
ug
h,
Can
terb
ury
, th
e
West
Coast,
a
nd
So
uth
lan
d,
bu
t re
main
ing
m
ore
sta
tic
in
So
uth
C
an
terb
ury
an
d O
tago
. D
uri
ng 2
01
0,
the
pro
po
rtio
n o
f E
uro
pe
an
bab
ies b
orn
w
as h
igh
er
tha
n t
he
New
Ze
ala
nd
ra
te i
n a
ll o
f th
e S
ou
th I
sla
nd
DH
Bs,
wh
ile
the
p
rop
ort
ion
of
Mā
ori
, P
acific
a
nd
A
sia
n/I
nd
ian
b
abie
s
wa
s
low
er.
T
he
p
rop
ort
ion o
f b
ab
ies b
orn
in
to t
he
most
de
pri
ve
d (
NZ
Dep
de
cile
9-1
0)
are
as
wa
s m
uch
lo
we
r th
an t
he
New
Ze
ala
nd r
ate
in
Nels
on
Ma
rlb
oro
ug
h,
So
uth
C
an
terb
ury
, C
an
terb
ury
, O
tag
o
an
d
Sou
thla
nd.
In
the
West
Coa
st,
th
e
pro
po
rtio
n (
wh
ile s
till
low
er)
wa
s c
lose
r to
th
e N
ew
Ze
ala
nd
ra
te.
Fe
tal D
ea
ths
In
New
Z
ea
lan
d
du
rin
g
200
4–
200
8,
unsp
ecifie
d
cau
se
wa
s
the
most
fre
qu
en
tly lis
ted
fe
tal
cau
se
of
inte
rmed
iate
fe
tal
dea
ths (I
FD
), fo
llow
ed
b
y
extr
em
e i
mm
atu
rity
/lo
w b
irth
we
igh
t. C
ong
en
ita
l a
nd
ch
rom
osom
al
ano
malie
s
als
o m
ad
e a
sig
nific
an
t co
ntr
ibu
tio
n.
Of
IFD
s w
ith
a m
ate
rna
l ca
use
lis
ted
, th
e
mo
st
fre
que
nt
ca
use
s w
ere
pla
cen
ta p
rae
via
/ s
epa
ratio
n/h
ae
mo
rrh
age
and
ch
orio
am
nio
nitis
. U
nsp
ecifie
d c
ause
wa
s a
lso
th
e m
ost
fre
qu
en
tly l
iste
d f
eta
l ca
use
of
late
feta
l de
ath
s (
LF
D),
fo
llow
ed
by m
aln
utr
itio
n/s
low
fe
tal
gro
wth
. C
on
ge
nita
l a
nd
ch
rom
osom
al
an
om
alie
s
ag
ain
m
ad
e
a
sig
nific
ant
co
ntr
ibu
tio
n.
Of
LF
Ds w
ith
a m
ate
rna
l ca
use
lis
ted
, th
e m
ost
fre
qu
en
t cau
ses
we
re
pla
ce
nta
p
rae
via
/
sepa
ration
/
ha
em
orr
hag
e
/ o
the
r a
no
ma
ly,
an
d
co
mp
ressio
n o
f th
e u
mb
ilical co
rd.
In t
he
So
uth
Isla
nd
du
ring
200
0–
200
8,
larg
e y
ea
r to
ye
ar
va
ria
tio
ns (
like
ly a
s
the
re
sult o
f sm
all
num
be
rs)
ma
de
tre
nd
s i
n I
FD
an
d L
FD
ra
tes d
ifficult t
o
inte
rpre
t D
urin
g 20
04–
20
08
, w
hile
th
ere
w
as s
om
e re
gio
na
l va
ria
bili
ty,
IFD
a
nd
LF
D r
ate
s w
ere
no
t sig
nific
an
tly d
iffe
ren
t fr
om
th
e N
ew
Ze
ala
nd
ra
te i
n
an
y o
f th
e S
ou
th Isla
nd
DH
Bs.
Du
rin
g
20
04–
20
08
, e
xtr
em
e
imm
atu
rity
/lo
w
bir
th
we
igh
t,
co
ng
enita
l a
nd
ch
rom
oso
mal
an
om
alie
s a
nd
un
spe
cifie
d c
ause
s w
ere
fre
qu
en
tly l
iste
d f
eta
l ca
use
s o
f IF
Ds.
Of
tho
se
IF
Ds w
hic
h h
ad
a m
ate
rnal
cau
se
lis
ted
, fr
eq
uen
t ca
use
s w
ere
pla
ce
nta
pra
evia
/ o
the
r p
lace
nta
l a
nom
alie
s,
inco
mp
ete
nt
ce
rvix
/
pre
ma
ture
ru
ptu
re
of
the
m
em
bra
nes
an
d
ch
ori
oa
mn
ion
itis
. U
nsp
ecifie
d
ca
use
s,
intr
au
terin
e h
yp
oxia
an
d c
on
ge
nia
l a
nd
ch
rom
oso
ma
l a
nom
alie
s w
ere
a
lso
co
mm
on
fe
tal
ca
use
s of
LF
Ds.
Of
tho
se
LF
Ds w
hic
h h
ad
a
m
ate
rna
l ca
use
lis
ted
, fr
eq
ue
nt
ca
use
s
we
re
pla
cen
ta
pra
evia
/
oth
er
pla
ce
nta
l a
no
ma
lies a
nd
com
pre
ssio
n o
f th
e u
mb
ilica
l co
rd .
Intr
odu
ctio
n a
nd
Ove
rvie
w -
33
Ind
ica
tor
New
Ze
ala
nd
Dis
trib
utio
n a
nd
Tre
nd
s
So
uth
Isla
nd
Dis
trib
utio
n a
nd
Tre
nd
s
Pre
term
Bir
th
In N
ew
Ze
ala
nd
du
rin
g 2
00
0–2
01
0,
pre
term
bir
th r
ate
s w
ere
re
lative
ly s
tatic.
Duri
ng
2
00
6–
201
0,
pre
term
b
irth
ra
tes w
ere
sig
nific
an
tly h
igh
er
for
male
s,
Mā
ori
>
A
sia
n/I
nd
ian
, E
uro
pe
an
a
nd
P
acific
b
abie
s,
those
b
orn
in
to m
ore
d
ep
rive
d (
NZ
Dep
decile
6–
10)
are
as,
an
d b
ab
ies b
orn
to
you
ng
er
(<2
5 y
ea
rs)
or
old
er
(35+
ye
ars
) m
oth
ers
.
In N
els
on
M
arl
bo
rou
gh
, p
rete
rm b
irth
ra
tes d
eclin
ed
du
ring
th
e m
id-2
000
s,
with
ra
tes b
ein
g l
ow
er
tha
n t
he
New
Ze
ala
nd
ra
te f
or
the
ma
jority
of
20
00
–2
01
0,
wh
ile in S
ou
th C
ante
rbury
, ra
tes e
xh
ibite
d a
flu
ctu
atin
g u
pw
ard
tre
nd
. In
C
an
terb
ury
, th
e W
est
Coast,
Ota
go
an
d S
ou
thla
nd
ra
tes f
luctu
ate
d,
with
ra
tes
in O
tag
o b
ein
g c
on
sis
ten
tly h
igh
er
than
th
e N
ew
Ze
ala
nd
ra
te,
an
d r
ate
s in
the
oth
er
thre
e D
HB
s be
ing
sim
ilar
(alth
oug
h in
S
ou
thla
nd
ra
tes w
ere
h
ighe
r d
uri
ng t
he m
id-2
00
0s).
In
Nels
on
Ma
rlb
oro
ugh
a
nd
Ota
go
du
rin
g
20
00
–20
10
, th
ere
w
ere
no
co
nsis
ten
t d
iffe
rences in
p
rete
rm bir
th ra
tes be
twe
en
M
āo
ri a
nd E
uro
pe
an
ba
bie
s,
altho
ugh
in S
ou
th C
an
terb
ury
, th
e W
est
Coa
st
and S
ou
thla
nd,
rate
s
we
re h
igh
er
for
Mā
ori
th
an
fo
r E
uro
pe
an
b
abie
s du
ring
th
e la
te 20
00s.
In
ad
ditio
n,
pre
term
b
irth
ra
tes
in
So
uth
C
an
terb
ury
a
nd
West
Coa
st
Mā
ori
b
ab
ies
incre
ase
d
du
rin
g
this
p
erio
d,
alth
oug
h
it
is
uncle
ar
wh
eth
er
this
re
flecte
d cha
nge
s in
e
thnic
ity co
din
g o
r re
al
incre
ase
s in
th
e in
cid
ence
o
f p
rete
rm b
irth
.
Infa
nt
Mo
rta
lity
an
d
Su
dd
en U
ne
xp
ecte
d
Dea
th in
In
fan
cy
(SU
DI)
Neo
na
tal
an
d P
ost
Neo
na
tal
Mo
rta
lity:
In N
ew
Z
ea
lan
d d
uri
ng
1
990
–20
08,
ne
on
ata
l an
d p
ost
ne
ona
tal
mo
rtalit
y b
oth
declin
ed
. N
eo
na
tal
mo
rtalit
y w
as
hig
he
r fo
r P
acific
and
Mā
ori
> E
uro
pe
an
> A
sia
n/I
nd
ian
infa
nts
du
rin
g t
he la
te
19
90s,
alth
oug
h e
thn
ic d
iffe
ren
ces w
ere
le
ss co
nsis
ten
t d
uri
ng
th
e 2
00
0s.
Po
st
ne
on
ata
l m
ort
alit
y
wa
s
hig
he
r fo
r M
āo
ri
>
Pa
cific
>
E
uro
pe
an
a
nd
Asia
n/I
ndia
n
infa
nts
th
rough
ou
t 19
96–
20
08
. D
urin
g
20
04
–2
008
, b
oth
o
utc
om
es w
ere
als
o s
ignific
an
tly h
igh
er
for
male
s,
tho
se
in
ave
rag
e-t
o-m
ore
d
ep
rive
d a
reas,
pre
term
in
fan
ts a
nd
th
ose
with
yo
ung
er
mo
the
rs.
SU
DI:
In
New
Ze
ala
nd
, S
UD
I d
eclin
ed
du
rin
g t
he
late
19
90s–
ea
rly 2
00
0s,
bu
t
be
cam
e m
ore
sta
tic a
fte
r 2
00
2–
03.
Whe
n b
roke
n d
ow
n b
y s
ub
-typ
e,
SID
S
de
ath
s
declin
ed
du
ring
1
996
–2
008
, w
hile
th
ose
du
e
to
su
ffo
ca
tio
n
or
str
ang
ula
tion
in
be
d
be
cam
e
mo
re
pro
min
ent
as
the
peri
od
p
rog
ressed
. D
uri
ng
2
00
4–
200
8,
SU
DI
wa
s
hig
hest
in
infa
nts
4
–7
we
eks
of
ag
e.
Su
ffo
ca
tion
/ str
an
gu
latio
n i
n b
ed
a
cco
un
ted
fo
r 57
.1%
of
all
SU
DI
de
ath
s i
n
tho
se
age
d 0
–3
we
eks a
nd
36
.8%
of
SU
DI
de
ath
s i
n t
ho
se a
ge
d 4
–7 w
ee
ks.
SU
DI
wa
s
als
o
sig
nific
an
tly
hig
he
r fo
r M
āo
ri
>
Pa
cific
>
E
uro
pe
an
>
A
sia
n/I
ndia
n i
nfa
nts
, th
ose
fro
m a
ve
rage
-to
-mo
re d
ep
rive
d (
NZ
Dep
decile
3–
10
) a
rea
s, p
rete
rm in
fan
ts, a
nd
th
ose
wh
ose
mo
the
rs w
ere
<3
0 y
ea
rs o
f a
ge
.
Neo
na
tal an
d P
ost
Neo
na
tal M
ort
alit
y:
In t
he S
ou
th I
sla
nd
DH
Bs d
urin
g 2
00
4–
20
08
, con
ge
nital a
no
malie
s a
nd
extr
em
e p
rem
atu
rity
we
re f
req
ue
nt
ca
use
s o
f n
eo
nata
l m
ort
alit
y,
alth
ou
gh
in
trau
terin
e/b
irth
a
sp
hyxia
a
lso
m
ad
e
a
co
ntr
ibu
tio
n i
n s
om
e D
HB
s.
SU
DI
an
d co
nge
nita
l an
om
alie
s w
ere
fr
eq
ue
nt
ca
use
s
of
post
ne
ona
tal
mo
rta
lity.
While
th
ere
w
ere
re
gio
nal
va
ria
tio
ns,
ne
on
ata
l m
ort
alit
y r
ate
s w
ere
no
t sig
nific
antly d
iffe
ren
t fr
om
th
e N
ew
Ze
ala
nd
rate
in
an
y o
f th
e D
HB
s.
Po
st
ne
on
ata
l m
ort
alit
y r
ate
s w
ere
lo
we
r th
an
the
New
Ze
ala
nd
ra
te in
Nels
on
Ma
rlb
oro
ug
h,
Can
terb
ury
, S
outh
Can
terb
ury
an
d
Ota
go
, a
lth
oug
h o
nly
in
th
e c
ase
of
Nels
on
Ma
rlb
oro
ug
h a
nd
Can
terb
ury
did
th
ese
diffe
rences r
each
sta
tistica
l sig
nific
ance
. S
imila
rly,
wh
ile h
igh
er,
rate
s in
So
uth
lan
d w
ere
not
sig
nific
an
tly d
iffe
rent
from
the
Ne
w Z
ea
lan
d r
ate
.
SU
DI:
In
th
e
So
uth
Is
lan
d
DH
Bs
du
ring
1
99
6–
20
08
, la
rge
ye
ar
to
ye
ar
va
ria
tio
ns m
ad
e p
recis
e i
nte
rpre
tatio
n o
f S
UD
I tr
en
ds d
ifficult,
alth
oug
h r
ate
s
in N
els
on
Ma
rlb
oro
ugh
, C
an
terb
ury
an
d O
tag
o e
xh
ibite
d a
ge
ne
ral d
ow
nw
ard
tr
en
d.
In C
ante
rbu
ry a
nd
Ota
go
du
rin
g 2
004
–20
08
, S
UD
I ra
tes w
ere
lo
we
r th
an
th
e N
ew
Ze
ala
nd
ra
te,
alth
ou
gh o
nly
in
the
ca
se
of
Cante
rbu
ry d
id t
hese
diffe
ren
ce
s r
each
sta
tistica
l sig
nific
ance
. S
UD
I ra
tes i
n S
ou
thla
nd
we
re n
ot
sig
nific
an
tly d
iffe
rent
from
th
e N
ew
Ze
ala
nd
ra
te,
wh
ile in
Nels
on M
arl
bo
rou
gh
an
d S
ou
th C
an
terb
ury
sm
all
nu
mb
ers
pre
clu
ded
a v
alid
com
pa
riso
n.
No
SU
DI
de
ath
s o
ccu
rre
d in
th
e W
est
Co
ast d
urin
g t
his
pe
rio
d.
Intr
odu
ctio
n a
nd
Ove
rvie
w -
34
Ind
ica
tor
New
Ze
ala
nd
Dis
trib
utio
n a
nd
Tre
nd
s
So
uth
Isla
nd
Dis
trib
utio
n a
nd
Tre
nd
s
Bre
astfe
edin
g
In N
ew
Ze
ala
nd d
urin
g J
un
e 2
00
4–2
011
, th
e p
rop
ort
ion
of
ba
bie
s e
xclu
siv
ely
o
r fu
lly b
rea
stf
ed
re
ma
ined
fa
irly
sta
tic,
with
ra
tes i
n t
he
ye
ar
en
din
g J
une
20
11
be
ing
66
.3%
at
<6
we
eks,
54
.9%
at
3 m
on
ths a
nd
25
.2%
at
6 m
on
ths.
Exclu
siv
e/fu
ll b
rea
stfe
edin
g ra
tes a
t <
6 w
ee
ks w
ere
co
nsis
ten
tly h
igh
er
for
Eu
rop
ean
/Oth
er
ba
bie
s t
ha
n f
or
ba
bie
s o
f o
the
r e
thn
ic g
rou
ps.
At
3 a
nd
6
mo
nth
s h
ow
eve
r, r
ate
s w
ere
ge
ne
rally
hig
he
r E
uro
pe
an
/Oth
er
> A
sia
n/In
dia
n
> M
āo
ri a
nd P
acific
ba
bie
s,
with
diffe
ren
ces b
etw
ee
n A
sia
n/In
dia
n a
nd
Mā
ori
a
nd
Pacific
ba
bie
s incre
asin
g a
s t
he
pe
rio
d p
rog
resse
d.
In
Nels
on
M
arl
bo
roug
h
an
d
Ota
go
d
uri
ng
Ju
ne
2
00
4–2
01
1,
exclu
siv
e/f
ull
bre
astf
eed
ing ra
tes at
<6 w
ee
ks a
nd 3
mo
nth
s w
ere
hig
he
r th
an
th
e N
ew
Z
ea
lan
d r
ate
, w
hile
ra
tes i
n S
ou
th C
an
terb
ury
an
d S
ou
thla
nd
we
re s
imila
r.
Rate
s in
th
e W
est
Co
ast
incre
ased
, w
ith
ra
tes b
ein
g h
ighe
r th
an
th
e N
ew
Z
ea
lan
d
rate
d
urin
g
the
la
te
20
00
s,
wh
ile
rate
s
in
Can
terb
ury
g
rad
ually
d
eclin
ed
, b
eco
min
g s
imila
r to
th
e N
ew
Ze
ala
nd
ra
te d
urin
g t
he
la
te 2
00
0s.
In
Nels
on
M
arl
bo
rou
gh
, C
an
terb
ury
, O
tag
o
an
d
So
uth
land
d
uri
ng
20
11
, b
rea
stf
eed
ing
ra
tes at
all
thre
e a
ges w
ere
lo
we
r fo
r b
ab
ies fr
om
th
e m
ost
de
pri
ve
d (
NZ
Dep
de
cile
10
vs.
1)
are
as.
Sim
ilar
patt
ern
s w
ere
se
en
in
So
uth
C
an
terb
ury
a
t <
6 w
ee
ks a
nd 3
m
on
ths,
alth
ou
gh
in
th
e W
est
Coast
sm
all
nu
mbe
rs p
reclu
de
d a
va
lid c
om
pa
rison
. In
Nels
on
Ma
rlb
oro
ug
h,
Cante
rbu
ry,
So
uth
C
an
terb
ury
, O
tago
a
nd
S
ou
thla
nd
d
uri
ng
2
00
4–
201
1,
bre
astfe
edin
g
rate
s a
t all
thre
e a
ge
s w
ere
hig
he
r fo
r E
uro
pe
an
/Oth
er
bab
ies t
ha
n f
or
Mā
ori
b
ab
ies.
In t
he
West
Co
ast h
ow
eve
r, e
thnic
diffe
rences w
ere
le
ss c
on
sis
ten
t.
Issue
s M
ore
Co
mm
on in
Child
ren
or
in C
hild
ren
and
Yo
un
g P
eo
ple
To
tal a
nd
Avoid
able
Mo
rbid
ity a
nd
Mo
rta
lity
Mo
st
Fre
qu
en
t C
au
ses o
f H
ospita
l A
dm
issio
n a
nd
M
ort
alit
y in
Ch
ildre
n
In N
ew
Ze
ala
nd
du
rin
g 2
006
–2
01
0,
inju
ry/p
ois
on
ing
an
d g
astr
oen
teritis w
ere
th
e m
ost
fre
que
nt
rea
so
ns fo
r a
cu
te h
osp
ita
l a
dm
issio
ns in
child
ren
, w
hile
n
eo
pla
sm
s/c
he
mo
the
rap
y/r
ad
ioth
era
py
an
d
inju
ry/p
ois
on
ing
w
ere
th
e
mo
st
fre
qu
en
t re
aso
ns f
or
arr
ang
ed a
dm
issio
ns.
Den
tal
pro
ce
du
res a
nd
gro
mm
ets
w
ere
th
e m
ost
fre
qu
en
t re
asons f
or
a w
aitin
g lis
t a
dm
issio
n.
Duri
ng
20
04
–2
00
8,
ne
op
lasm
s w
ere
th
e m
ost
fre
qu
en
t ca
use
of
mo
rtalit
y i
n
ch
ildre
n
ag
ed
1
–1
4
ye
ars
, fo
llow
ed
b
y
co
nge
nita
l a
no
ma
lies
an
d
ve
hic
le
occu
pa
nt
tra
nspo
rt in
jurie
s.
In t
he
So
uth
Isla
nd
DH
Bs d
uri
ng
20
06
–2
010
, in
jury
/pois
onin
g,
acu
te u
pp
er
resp
ira
tory
tra
ct
infe
ction
s a
nd g
astr
oen
teritis w
ere
th
e m
ost
fre
qu
en
t re
aso
ns
for
an
acu
te
hosp
ita
l a
dm
issio
n
in
ch
ildre
n.
Neop
lasm
s/c
hem
oth
era
py/
rad
ioth
era
py,
inju
ry/p
ois
on
ing
, d
en
tal co
nditio
ns a
nd
meta
bolic
dis
ord
ers
we
re
the
mo
st
freq
ue
nt
rea
son
s f
or
arr
ang
ed
ad
mis
sio
ns,
wh
ile d
en
tal
pro
ce
du
res,
gro
mm
ets
, to
nsill
ecto
my +
/− a
de
no
idecto
my a
nd
mu
scu
loske
leta
l p
roce
du
res
we
re t
he
mo
st
fre
qu
en
t re
aso
ns f
or
a w
aitin
g l
ist
ad
mis
sio
n.
Durin
g 2
004
–2
00
8,
ne
op
lasm
s,
co
nge
nita
l a
no
ma
lies,
tra
nsp
ort
inju
rie
s (
ve
hic
le o
ccup
ant
an
d p
ede
str
ian
) a
nd
d
row
nin
g/s
ub
me
rsio
n w
ere
a
mo
ng
th
e m
ost
fre
que
nt
ca
use
s o
f m
ort
alit
y in
child
ren
ag
ed
1–
14 y
ea
rs.
Am
bu
lato
ry S
ensitiv
e
Hosp
ita
lisa
tio
ns
(AS
H)
In N
ew
Z
ea
lan
d d
urin
g 2
00
6–
20
10,
ga
str
oe
nte
ritis,
acute
up
pe
r re
sp
ira
tory
in
fection
s a
nd
asth
ma
we
re t
he
mo
st
fre
que
nt
ca
use
s o
f A
SH
in
ch
ildre
n 0
–4
ye
ars
w
he
n
em
erg
en
cy
dep
art
me
nt
(ED
) case
s
we
re
inclu
de
d,
wh
ile
ga
str
oe
nte
ritis,
de
nta
l con
ditio
ns a
nd a
sth
ma
we
re t
he
mo
st
fre
qu
en
t cau
se
s
wh
en
ED
case
s w
ere
exclu
ded
. W
hen
bro
ke
n d
ow
n b
y a
ge,
AS
H r
ate
s w
ere
h
igh
est
in in
fan
ts a
nd
o
ne
ye
ar
old
s,
with
ra
tes th
en
ta
pe
rin
g o
ff ra
pid
ly
be
twe
en
on
e a
nd
tw
o y
ea
rs,
an
d t
he
n a
ga
in b
etw
ee
n f
ou
r an
d s
eve
n y
ea
rs o
f a
ge
. A
SH
ra
tes w
ere
als
o sig
nific
antly h
igh
er
for
male
s,
Pa
cific
> M
āo
ri >
A
sia
n/I
ndia
n >
Eu
rop
ean
child
ren
and
th
ose
fro
m a
ve
rag
e-t
o-m
ore
de
prive
d
(NZ
Dep
de
cile
3–
10
) a
reas.
Sim
ilar
pa
tte
rns w
ere
se
en
wh
en
ED
ca
se
s w
ere
e
xclu
de
d,
altho
ugh
ad
mis
sio
n r
ate
s f
or
Asia
n/I
ndia
n w
ere
sig
nific
an
tly l
ow
er
tha
n fo
r E
uro
pe
an
child
ren
.
Am
on
gst
the
S
ou
th
Isla
nd
D
HB
s
du
rin
g
200
0–2
01
0,
ED
in
clu
de
d
and
exclu
de
d
AS
H
rate
s
in
ch
ildre
n
0–
4
ye
ars
d
iffe
red
ve
ry
little
, p
ote
ntia
lly
su
gge
stin
g t
ha
t th
e w
ay t
he
So
uth
Isla
nd
DH
Bs a
re m
an
ag
ing
/co
din
g t
heir
ED
ca
se
s
diffe
rs
from
so
me
oth
er
DH
Bs.
In
Nels
on
M
arl
bo
roug
h,
Sou
th
Can
terb
ury
an
d O
tago
AS
H r
ate
s w
ere
rela
tive
ly s
tatic,
wh
ile i
n C
an
terb
ury
a
nd
the
West
Coast
rate
s e
xh
ibite
d a
flu
ctu
ating
do
wn
wa
rd t
ren
d.
In c
ontr
ast,
ra
tes i
n S
ou
thla
nd
decre
ase
d d
uri
ng
th
e e
arl
y 2
00
0s,
bu
t ra
pid
ly i
ncre
ased
ag
ain
afte
r 2
00
6-0
7.
In C
an
terb
ury
, A
SH
ra
tes w
ere
hig
he
r fo
r P
acific
ch
ildre
n
tha
n fo
r ch
ildre
n o
f o
the
r e
thn
ic g
rou
ps.
While
A
SH
ra
tes w
ere
h
igh
er
for
Mā
ori
ch
ildre
n
tha
n
for
Eu
rop
ea
n
child
ren
in
N
els
on
M
arl
bo
rou
gh
an
d
So
uth
lan
d d
urin
g t
he m
id-l
ate
20
00
s,
eth
nic
diffe
ren
ces i
n S
ou
th C
an
terb
ury
, th
e W
est
Coa
st
and
Ota
go
were
le
ss c
on
sis
ten
t. I
n C
an
terb
ury
, O
tag
o a
nd
So
uth
lan
d d
urin
g 2
00
6–2
01
0,
AS
H w
ere
ge
ne
rally
hig
he
r in
win
ter
an
d s
pri
ng
, a
lth
ou
gh
in
Nels
on
Ma
rlb
oro
ug
h,
So
uth
C
an
terb
ury
an
d
the
W
est
Coast
se
aso
nal va
riatio
ns w
ere
less e
vid
en
t .
Intr
odu
ctio
n a
nd
Ove
rvie
w -
35
Ind
ica
tor
New
Ze
ala
nd
Dis
trib
utio
n a
nd
Tre
nd
s
So
uth
Isla
nd
Dis
trib
utio
n a
nd
Tre
nd
s
Upp
er
Re
sp
irato
ry T
ract
Cond
itio
ns
Acu
te U
pp
er
Resp
ira
tory
Tra
ct
Infe
ctio
ns a
nd
T
on
sill
ecto
my
Acu
te U
pp
er
Resp
ira
tory
In
fectio
ns:
In N
ew
Ze
ala
nd
du
rin
g 2
00
6–2
010
, a
cute
u
pp
er
resp
ira
tory
tra
ct
infe
ction
s (
UR
TI)
of
mu
ltip
le/u
nspe
cifie
d s
ite
s w
ere
th
e
mo
st
fre
qu
en
t re
aso
n
for
an
U
RT
I a
dm
issio
n
in
ch
ildre
n,
follo
we
d
by
cro
up/a
cu
te
lary
ng
itis
/tra
che
itis
. U
RT
I a
dm
issio
ns
we
re
mo
st
com
mon
in
in
fants
an
d on
e ye
ar
old
s,
with
ra
tes ta
pe
rin
g off
ra
pid
ly th
ere
afte
r. R
ate
s
we
re
als
o
sig
nific
an
tly
hig
her
for
ma
les,
Pa
cific
>
M
āo
ri
>
Eu
rop
ean
>
A
sia
n/I
ndia
n c
hild
ren a
nd t
hose
in
ave
rag
e-t
o-m
ore
de
prive
d (
NZ
Dep
de
cile
4
–1
0)
are
as.
To
nsill
ecto
my:
In N
ew
Ze
ala
nd
du
rin
g 2
00
6–2
010
, ch
ron
ic t
on
sill
itis
wa
s t
he
m
ost
freq
ue
nt
prim
ary
dia
gn
osis
in
ch
ildre
n
adm
itte
d
to
ho
spital
for
ton
sill
ecto
my +
/− a
de
no
ide
cto
my,
acco
un
ting
fo
r 6
0.1
% o
f a
ll a
dm
issio
ns.
Hyp
ert
rop
hy
of
the
to
nsils
/ad
en
oid
s
wa
s
the
se
co
nd
le
ad
ing
dia
gn
osis
, fo
llow
ed
by s
leep
apn
oea
. A
dm
issio
ns incre
ase
d d
urin
g t
he p
re-s
ch
oo
l ye
ars
, to
re
ach
th
eir
hig
he
st
poin
t at
fou
r ye
ars
of
ag
e in
Eu
rop
ean a
nd
Asia
n/I
ndia
n
ch
ildre
n,
at
five
ye
ars
of
age i
n M
āo
ri c
hild
ren
, an
d a
t six
ye
ars
of
ag
e i
n
Pa
cific
ch
ildre
n.
Ove
rall,
adm
issio
ns w
ere
sig
nific
antly h
ighe
r fo
r E
uro
pe
an
>
Mā
ori
>
A
sia
n/I
ndia
n a
nd
P
acific
ch
ildre
n,
and
sig
nific
an
tly lo
we
r fo
r th
ose
livin
g in
the
le
ast d
epri
ve
d (
NZ
Dep
decile
1)
are
as.
Acu
te U
pp
er
Resp
irato
ry I
nfe
ctio
ns:
In C
ante
rbu
ry a
nd t
he
West
Coast
du
ring
20
00
–2
010
, ho
spital
ad
mis
sio
ns f
or
UR
TI
in c
hild
ren
de
clin
ed
, w
hile
in S
ou
th
Can
terb
ury
adm
issio
ns i
ncre
ase
d.
In c
on
trast,
ra
tes i
n N
els
on M
arl
bo
rou
gh,
Ota
go
and
So
uth
lan
d f
luctu
ate
d f
rom
ye
ar
to y
ea
r. I
n C
an
terb
ury
adm
issio
ns
we
re
hig
he
r fo
r P
acific
>
E
uro
pe
an
>
A
sia
n/In
dia
n
ch
ildre
n,
altho
ugh
d
iffe
ren
ce
s f
or
Mā
ori
child
ren w
ere
mo
re v
ari
ab
le.
In t
he
oth
er
So
uth
Isla
nd
DH
Bs,
no
con
sis
ten
t d
iffe
rence
s w
ere
se
en
b
etw
ee
n M
āo
ri a
nd
E
uro
pea
n
ch
ildre
n. A
dm
issio
ns in
all
DH
Bs w
ere
hig
he
st d
urin
g th
e c
oo
ler
mo
nth
s.
To
nsill
ecto
my:
In
Nels
on
M
arl
bo
rou
gh
a
nd
S
ou
th
Cante
rbu
ry,
arr
ang
ed
/ w
aitin
g
list
ad
mis
sio
ns
for
ton
sill
ecto
my
+/−
a
de
no
idecto
my
in
ch
ildre
n
flu
ctu
ate
d d
uri
ng t
he
ea
rly-m
id 2
00
0s,
bu
t in
cre
ase
d r
ap
idly
aft
er
20
06
–0
7.
In
Can
terb
ury
ad
mis
sio
ns d
eclin
ed
du
rin
g t
he
ea
rly-2
00
0s,
rea
ch
ed
the
ir l
ow
est
po
int
in 2
00
2–0
3 a
nd
th
en
gra
du
ally
in
cre
ased
aga
in,
wh
ile in
th
e W
est
Coast
rate
s e
xh
ibite
d a
d
ow
nw
ard
tr
en
d.
In O
tag
o,
adm
issio
ns in
cre
ased
ra
pid
ly
du
rin
g t
he m
id-l
ate
20
00s,
wh
ile i
n S
outh
lan
d,
ad
mis
sio
ns d
ecre
ased
du
ring
the
ea
rly 2
000
s,
bu
t in
cre
ase
d a
ga
in a
fte
r 2
00
4–0
5.
In C
an
terb
ury
ad
mis
sio
ns
we
re g
en
era
lly h
ighe
r fo
r E
uro
pe
an
an
d M
āo
ri c
hild
ren
th
an
fo
r P
acific
and
Asia
n/I
ndia
n c
hild
ren
, w
hile
in N
els
on
Ma
rlb
oro
ug
h,
So
uth
Can
terb
ury
, O
tago
a
nd
S
ou
thla
nd
, ra
tes
we
re
ge
ne
rally
hig
he
r fo
r E
uro
pe
an
th
an
fo
r M
āo
ri
ch
ildre
n. In
th
e W
est
Co
ast
how
eve
r, e
thn
ic d
iffe
rence
s w
ere
le
ss c
onsis
ten
t.
Mid
dle
Ea
r C
on
ditio
ns:
Otitis
Me
dia
an
d G
rom
me
ts
In
New
Z
ea
lan
d
du
rin
g
2006
–2
010
, o
titis
me
dia
w
as
the
m
ost
fre
que
nt
pri
ma
ry d
iagn
osis
in t
hose
adm
itte
d a
cu
tely
with
con
ditio
ns o
f th
e m
iddle
ea
r a
nd
ma
sto
id,
as w
ell
as f
or
tho
se
ad
mitte
d s
em
i-acu
tely
/fro
m t
he
wa
itin
g l
ist
for
the inse
rtio
n o
f g
rom
me
ts.
Acu
te a
dm
issio
ns f
or
otitis m
ed
ia w
ere
hig
he
st
in i
nfa
nts
an
d o
ne
ye
ar
old
s,
with
ra
tes d
eclin
ing
rap
idly
th
ere
aft
er.
Rate
s w
ere
hig
he
r fo
r M
āo
ri a
nd
Pacific
>
Eu
rop
ea
n >
Asia
n/I
nd
ian
child
ren
du
rin
g t
he
first
fou
r ye
ars
, a
lth
oug
h e
thn
ic
diffe
ren
ce
s w
ere
less c
onsis
ten
t th
ere
afte
r. I
n c
on
tra
st, a
rra
ng
ed/w
aitin
g l
ist
ad
mis
sio
ns f
or
the
inse
rtio
n o
f g
rom
me
ts w
ere
re
lative
ly in
fre
qu
ent
du
ring
the
firs
t ye
ar
of
life,
bu
t in
cre
ase
d r
ap
idly
th
ere
aft
er.
Rate
s r
ea
ch
ed
th
eir
hig
hest
po
int
in E
uro
pe
an
child
ren
a
t o
ne
ye
ar,
in
M
āo
ri ch
ildre
n a
t tw
o ye
ars
, in
A
sia
n/I
ndia
n c
hild
ren
at
fou
r ye
ars
an
d in
Pa
cific
ch
ildre
n a
t six
ye
ars
of
ag
e.
Ove
rall,
du
rin
g t
he
fir
st
fou
r ye
ars
ad
mis
sio
ns w
ere
hig
he
r fo
r E
uro
pe
an
and
Mā
ori
> P
acific
> A
sia
n/In
dia
n c
hild
r en
, w
hile
aft
er
six
ye
ars
, a
dm
issio
ns w
ere
h
igh
er
for
Pa
cific
> M
āo
ri >
Euro
pe
an >
Asia
n/I
ndia
n c
hild
ren.
In th
e S
ou
th Is
land
d
uri
ng 20
06
–20
10
, o
titis m
ed
ia w
as th
e m
ost
fre
qu
en
t p
rim
ary
dia
gn
osis
in t
hose
adm
itte
d a
cu
tely
with
con
ditio
ns o
f th
e m
iddle
ea
r a
nd
ma
sto
id,
as w
ell
as f
or
tho
se
ad
mitte
d s
em
i-acu
tely
/fro
m t
he
wa
itin
g l
ist
for
the inse
rtio
n o
f g
rom
me
ts.
In N
els
on
Ma
rlb
oro
ug
h,
the
West
Coast,
Can
terb
ury
, S
outh
Can
terb
ury
an
d
Ota
go
, acu
te a
dm
issio
ns f
or
otitis m
ed
ia w
ere
lo
we
r th
an
th
e N
ew
Ze
ala
nd
ra
te,
alth
oug
h o
nly
in
Nels
on M
arl
bo
roug
h a
nd
So
uth
Cante
rbu
ry d
id t
he
se
diffe
ren
ce
s r
ea
ch
sta
tistical sig
nific
ance
. R
ate
s in
So
uth
lan
d w
ere
sig
nific
antly
hig
he
r th
an
th
e N
ew
Ze
ala
nd r
ate
. In
co
ntr
ast, g
rom
me
ts a
dm
issio
ns w
ere
sig
nific
an
tly
low
er
tha
n
the
New
Z
ea
lan
d
rate
in
th
e
West
Coast
and
C
an
terb
ury
, b
ut
sig
nific
antly
hig
he
r in
S
ou
th
Can
terb
ury
, O
tag
o
and
So
uth
lan
d, a
nd s
imila
r in
Ne
lso
n M
arl
bo
rou
gh
.
In C
an
terb
ury
, g
rom
me
ts a
dm
issio
ns w
ere
g
en
era
lly h
ighe
r fo
r P
acific
an
d
Mā
ori
>
E
uro
pe
an
>
A
sia
n/In
dia
n
child
ren
, w
hile
in
th
e
West
Coa
st
and
So
uth
lan
d a
dm
issio
ns w
ere
g
en
era
lly h
ighe
r fo
r M
āo
ri th
an
fo
r E
uro
pea
n
ch
ildre
n.
In O
tag
o (
with
th
e e
xce
ptio
n o
f 2
010
) a
dm
issio
ns w
ere
hig
he
r fo
r E
uro
pe
an
th
an
fo
r M
āo
ri child
ren
, w
hile
in
N
els
on
M
arl
boro
ug
h an
d S
ou
th
Can
terb
ury
eth
ni c
diffe
ren
ce
s w
ere
le
ss c
onsis
tent.
Intr
odu
ctio
n a
nd
Ove
rvie
w -
36
Ind
ica
tor
New
Ze
ala
nd
Dis
trib
utio
n a
nd
Tre
nd
s
So
uth
Isla
nd
Dis
trib
utio
n a
nd
Tre
nd
s
Lo
we
r R
esp
irato
ry T
ract
Cond
itio
ns
Bro
nchio
litis
In N
ew
Ze
ala
nd
du
rin
g 2
00
0–
20
10,
bro
nchio
litis
adm
issio
ns r
em
ain
ed
sta
tic
du
rin
g t
he
ea
rly-m
id 2
000
s,
bu
t th
en
incre
ase
d b
etw
ee
n 2
00
6–
07
an
d 2
008
–0
9.
On
a
ve
rag
e
du
rin
g
200
0–
200
8,
on
e
infa
nt
each
ye
ar
die
d
from
b
ron
ch
iolit
is.
Durin
g 2
00
6–
201
0,
bro
nchio
litis
a
dm
issio
ns w
ere
sig
nific
an
tly
hig
he
r fo
r m
ale
s,
Pa
cific
> M
āo
ri >
Eu
rop
ea
n >
Asia
n/In
dia
n in
fants
an
d t
hose
fro
m a
ve
rag
e-t
o-m
ore
dep
rived
(N
ZD
ep
de
cile
3–
10
) a
reas.
In e
ach o
f th
e S
outh
Isla
nd D
HB
s d
urin
g 2
00
6–
20
10,
bro
nch
iolit
is a
dm
issio
ns
in i
nfa
nts
we
re s
ign
ific
an
tly l
ow
er
tha
n t
he
New
Ze
ala
nd
rate
. In
Can
terb
ury
d
uri
ng
20
00
–2
010
, a
dm
issio
ns w
ere
hig
he
r fo
r P
acific
> M
āo
ri >
Eu
rop
ea
n >
A
sia
n/I
ndia
n in
fan
ts,
alth
oug
h in
th
e W
est
Coa
st
no
con
sis
ten
t diffe
ren
ce
s
we
re se
en
b
etw
ee
n M
āo
ri a
nd
E
uro
pe
an
in
fan
ts.
In N
els
on
M
arl
bo
roug
h,
So
uth
Cante
rbu
ry,
Ota
go
an
d S
ou
thla
nd
, w
hile
eth
nic
diffe
ren
ces w
ere
no
t co
nsis
ten
t, a
dm
issio
ns w
ere
hig
he
r fo
r M
āo
ri in
fan
ts t
ha
n f
or
Eu
rop
ean
in
fan
ts
in a
num
be
r o
f ye
ars
. A
dm
issio
ns h
ow
eve
r, w
ere
hig
he
r d
uri
ng w
inte
r an
d
ea
rly s
pr in
g in
all
So
uth
Isla
nd D
HB
s.
Pn
eu
mo
nia
In N
ew
Ze
ala
nd
, b
acte
ria
l /
no
n-v
ira
l /
unsp
ecifie
d p
ne
um
on
ia a
dm
issio
ns i
n
ch
ildre
n d
eclin
ed
du
rin
g 2
000
–2
00
7.
A s
mall
upsw
ing
in
ra
tes w
as e
vid
en
t in
2
00
8–0
9,
be
fore
ra
tes d
eclin
ed
aga
in i
n 2
01
0.
Sim
ilar
patt
ern
s w
ere
se
en f
or
yo
un
g
pe
ople
. In
co
ntr
ast,
vir
al
pn
eu
mo
nia
ad
mis
sio
ns
incre
ase
d
in
bo
th
ch
ildre
n a
nd y
ou
ng p
eop
le,
with
th
e m
ost
rap
id incre
ases in c
hild
ren
occu
rrin
g
be
twe
en
20
04
–05
and
200
8–
09
.
Pn
eu
mo
nia
ad
mis
sio
ns (
bo
th t
yp
es)
we
re h
igh
est
in o
ne
ye
ar
old
s,
with
th
e
ne
xt
hig
he
st
rate
s b
ein
g in
in
fan
ts <
1 y
ea
r. M
ort
alit
y w
as h
ighe
st
in infa
nts
< 1
ye
ar.
Ad
mis
sio
ns f
or
ba
cte
ria
l /
no
n-v
ira
l /
unsp
ecifie
d p
ne
um
on
ia i
n c
hild
ren
we
re a
lso
sig
nific
an
tly h
igh
er
for
ma
les,
Pacific
>
M
āo
ri >
A
sia
n/I
nd
ian
>
E
uro
pe
an
child
ren
an
d t
ho
se
in
ave
rag
e–m
ore
de
pri
ve
d (
NZ
Dep
de
cile
3–1
0)
are
as.
Fo
r yo
un
g p
eop
le,
adm
issio
ns w
ere
sig
nific
antly h
igh
er
for
Pacific
>
Mā
ori
> E
uro
pe
an
>A
sia
n/In
dia
n y
ou
ng
pe
op
le,
an
d t
hose
in a
ve
rag
e-t
o-m
ore
d
ep
rive
d (
NZ
Dep
decile
5–
10)
are
as.
Ad
mis
sio
ns f
or
vira
l p
ne
um
onia
we
re
hig
he
r fo
r P
acific
> M
āo
ri >
Eu
rop
ean
and
Asia
n/In
dia
n c
hild
ren
an
d t
ho
se
in
ave
rag
e-t
o-m
ore
dep
rive
d (
NZ
Dep
decile
6–1
0)
are
as.
In a
ll o
f th
e S
ou
th I
sla
nd
DH
Bs d
urin
g 2
00
6–
20
10
, ho
spita
l a
dm
issio
ns f
or
ba
cte
ria
l/n
on
-vir
al/un
sp
ecifie
d p
ne
um
onia
in
ch
ildre
n w
ere
sig
nific
an
tly l
ow
er
tha
n th
e N
ew
Z
ea
lan
d ra
te.
While
ad
mis
sio
ns in
yo
un
g pe
op
le w
ere
a
lso
low
er
tha
n t
he N
ew
Ze
ala
nd
ra
te,
on
ly i
n C
an
terb
ury
, S
ou
th C
an
terb
ury
and
Ota
go
did
th
ese
d
iffe
rences
reach
sta
tistical
sig
nific
an
ce.
Sim
ilarly,
wh
ile
ad
mis
sio
ns f
or
vir
al
pne
um
on
ia i
n c
hild
ren
we
re l
ow
er
tha
n t
he
New
Ze
ala
nd
rate
in a
ll D
HB
s,
on
ly i
n t
he
ca
se
of
Nels
on
Ma
rlb
oro
ug
h,
Ca
nte
rbu
ry,
Ota
go
an
d S
ou
thla
nd
did
th
ese
diffe
ren
ces r
ea
ch s
tatistica
l sig
nific
an
ce.
In
Can
terb
ury
d
uri
ng
2
000
–2
010
, a
dm
issio
ns
for
ba
cte
ria
l/n
on
-vir
al/
un
spe
cifie
d p
neu
mon
ia w
ere
hig
he
r fo
r P
acific
> M
āo
ri a
nd
Eu
rop
ean
> A
sia
n/
Ind
ian
child
ren
a
nd
yo
un
g
pe
op
le,
wh
ile
in
Nels
on
M
arl
bo
rou
gh
, S
ou
th
Can
terb
ury
, th
e
West
Coa
st
an
d
So
uth
lan
d
the
re
we
re
no
con
sis
ten
t d
iffe
ren
ce
s i
n a
dm
issio
ns b
etw
ee
n M
āo
ri a
nd
Eu
rop
ea
n c
hild
ren
an
d y
ou
ng
p
eo
ple
. A
dm
issio
ns in
Ota
go
we
re h
igh
er
for
Mā
ori
th
an
fo
r E
uro
pe
an
ch
ildre
n
an
d
yo
ung
p
eop
le.
Ad
mis
sio
ns
for
vir
al
and
b
acte
ria
l/n
on
-vir
al/un
spe
cifie
d
pn
eum
onia
we
re h
igh
er
in w
inte
r a
nd
ea
rly s
pri
ng
in
all
DH
Bs.
Asth
ma
In N
ew
Ze
ala
nd
du
rin
g 2
00
0–2
01
0,
asth
ma a
dm
issio
ns i
n c
hild
ren
gra
du
ally
in
cre
ased
, w
hile
adm
issio
ns i
n y
ou
ng
pe
ople
we
re m
ore
sta
tic a
fte
r 2
00
4–
20
05
. O
n a
ve
rage
d
uri
ng
2
00
0–
200
8,
five
ch
ildre
n o
r you
ng
p
eop
le ea
ch
ye
ar,
d
ied
fr
om
a
sth
ma.
Duri
ng
2
00
6–2
01
0,
ad
mis
sio
ns
we
re
rela
tive
ly
infr
equ
en
t d
urin
g i
nfa
ncy b
ut
incre
ase
d r
apid
ly t
he
rea
fte
r, r
ea
ch
ing
a p
eak a
t 2
ye
ars
of
ag
e.
In c
on
trast,
asth
ma
dea
ths w
ere
mo
st
fre
quen
t a
mo
ng
st
tho
se
in
th
eir
la
te t
een
s a
nd
ea
rly t
we
nties.
Asth
ma
adm
issio
ns in
ch
ildre
n w
ere
als
o
sig
nific
an
tly h
ighe
r fo
r m
ale
s,
Pa
cific
>
M
āo
ri >
A
sia
n/Ind
ian
>
E
uro
pe
an
ch
ildre
n a
nd
th
ose
liv
ing i
n ave
rag
e-t
o-m
ore
dep
rive
d (
NZ
Dep
decile
3–
10)
are
as.
In co
ntr
ast,
asth
ma
ad
mis
sio
ns
in
yo
un
g
pe
ople
w
ere
sig
nific
an
tly
hig
he
r fo
r fe
ma
les,
Pacific
an
d
Mā
ori
>
E
uro
pe
an
>
A
sia
n/I
ndia
n
yo
un
g
pe
op
le,
an
d th
ose
in a
ve
rage
-to
-mo
re d
ep
rive
d (
NZ
De
p d
ecile
4–
10
) a
rea
s.
In e
ach
of
the
Sou
th I
sla
nd D
HB
s d
urin
g 2
006
–2
01
0,
asth
ma
ad
mis
sio
ns i
n
ch
ildre
n w
ere
sig
nific
an
tly lo
we
r th
an t
he
Ne
w Z
ea
lan
d r
ate
. W
hile
adm
issio
ns
in y
ou
ng
peo
ple
we
re a
lso
lo
we
r th
an
the
New
Ze
ala
nd
ra
te in
all
DH
Bs,
on
ly
in
Nels
on
M
arl
bo
rou
gh,
Ca
nte
rbu
ry,
Ota
go
a
nd
S
ou
thla
nd
did
th
ese
diffe
ren
ce
s re
ach
sta
tistical
sig
nific
an
ce
. In
C
an
terb
ury
d
uri
ng
2
00
0–
20
10,
ad
mis
sio
ns w
ere
ge
ne
rally
hig
he
r fo
r P
acific
> M
āo
ri >
Eu
rop
ean
> A
sia
n/
Ind
ian
ch
ildre
n a
nd
yo
un
g p
eo
ple
, w
hile
in N
els
on
Ma
rlb
oro
ug
h,
Ota
go
an
d
So
uth
lan
d
asth
ma
a
dm
issio
ns
we
re
ge
ne
rally
h
igh
er
for
Mā
ori
th
an
fo
r E
uro
pe
an
ch
ildre
n a
nd
yo
ung
pe
op
le.
Eth
nic
diffe
ren
ce
s i
n S
ou
th C
an
terb
ury
a
nd
the
West
Coa
st
we
re le
ss c
onsis
ten
t fr
om
ye
ar
to y
ea
r.
Intr
odu
ctio
n a
nd
Ove
rvie
w -
37
Ind
ica
tor
New
Ze
ala
nd
Dis
trib
utio
n a
nd
Tre
nd
s
So
uth
Isla
nd
Dis
trib
utio
n a
nd
Tre
nd
s
Bro
nchie
cta
sis
In
New
Z
ea
land
, h
ospita
l a
dm
issio
ns fo
r ch
ildre
n a
nd
you
ng
pe
op
le
with
bro
nch
iecta
sis
in
cre
ase
d d
urin
g t
he
ea
rly 2
000
s,
reache
d a
pe
ak i
n 2
00
4–
05
an
d t
he
n d
eclin
ed
, w
ith
six
ch
ildre
n o
r yo
un
g p
eo
ple
ha
vin
g b
ron
chie
cta
sis
lis
ted
as th
eir
m
ain
un
de
rlyin
g cau
se
o
f d
ea
th du
ring
20
00
–20
08
. D
uri
ng
20
06
–2
010
, a
dm
issio
ns in
cre
ase
d r
ap
idly
aft
er
the
fir
st
ye
ar
of
life
, w
ith
ra
tes
rem
ain
ing
e
leva
ted d
urin
g child
ho
od
, b
ut
dro
pp
ing
a
wa
y a
mo
ngst
tho
se
in
th
eir
te
en
s a
nd
ea
rly t
we
ntie
s.
Ad
mis
sio
ns w
ere
als
o s
ign
ific
an
tly h
igh
er
for
Pa
cific
> M
āo
ri >
Asia
n/In
dia
n >
Eu
rop
ea
n c
hild
ren
an
d y
ou
ng
pe
ople
and
th
ose
in
ave
rag
e-t
o-m
ore
de
prive
d (
NZ
De
p d
ecile
3–
10)
are
as.
In N
els
on
Ma
rlb
oro
ug
h,
So
uth
Can
terb
ury
, C
an
terb
ury
, th
e W
est
Coast
an
d
Ota
go
du
rin
g 2
00
0–
20
10
, la
rge
ye
ar
to y
ea
r va
ria
tion
s (
as t
he
re
sult o
f sm
all
nu
mbe
rs)
mad
e t
rend
s i
n h
osp
ita
l a
dm
issio
ns f
or
ch
ildre
n a
nd
yo
ung
pe
ople
w
ith
b
ron
chie
cta
sis
d
ifficu
lt
to
inte
rpre
t.
In
So
uth
land
ho
we
ve
r,
rate
s
incre
ased
, w
ith
th
e m
ost
rap
id i
ncre
ases b
ein
g s
ee
n b
etw
ee
n 2
006
–0
7 a
nd
20
08
–0
9.
Du
rin
g 2
00
6–
20
10
, a
dm
issio
ns w
ere
sig
nific
an
tly lo
we
r th
an
th
e
New
Z
ea
lan
d ra
te in
N
els
on
Ma
rlb
oro
ug
h,
Cante
rbu
ry an
d O
tag
o,
wh
ile in
S
ou
thla
nd a
dm
issio
n ra
tes w
ere
sim
ilar.
S
ma
ll n
um
be
rs pre
clu
de
d a
va
lid
an
aly
sis
in
S
ou
th
Can
terb
ury
, w
hile
n
o
ad
mis
sio
ns
occu
rre
d
in
the
W
est
Coa
st d
uri
ng
this
pe
rio
d.
Infe
ctio
us D
ise
ases
Pe
rtu
ssis
In
New
Z
ea
lan
d
du
rin
g
20
00
–2
010
, h
osp
ita
l a
dm
issio
ns
for
pe
rtu
ssis
in
in
fants
fluctu
ate
d,
with
p
ea
ks
occu
rrin
g
in
200
0
an
d
20
04
. A
dm
issio
ns
rea
che
d t
he
ir l
ow
est
poin
t in
20
07
, w
ith
ra
tes i
ncre
asin
g g
rad
ua
lly t
he
rea
fte
r.
Duri
ng
th
e e
arl
y-m
id 2
00
0s o
ne
in
fan
t e
ach
ye
ar
die
d f
rom
pe
rtu
ssis
, alth
ou
gh
no
de
ath
s
occu
rred
du
rin
g
20
06
–2
00
8.
Duri
ng
2
00
6–
20
10,
pe
rtussis
a
dm
issio
ns
we
re
hig
hest
in
infa
nts
<
1
yea
r,
with
ra
tes
de
clin
ing
rapid
ly
the
rea
fte
r.
Sim
ilarl
y,
du
rin
g
20
04
–2
008
, a
ll p
ert
ussis
d
ea
ths
occu
rre
d
in
infa
nts
<1
ye
ar.
Ad
mis
sio
n r
ate
s w
ere
als
o s
ign
ific
an
tly h
ighe
r fo
r P
acific
and
M
āo
ri
>
Eu
rop
ea
n
>
Asia
n/In
dia
n
infa
nts
a
nd
th
ose
fr
om
m
ore
d
ep
rive
d
(NZ
Dep
decile
5–1
0)
are
as.
In
the
S
ou
th
Isla
nd
d
urin
g
20
00
–2
01
0,
the
re
we
re
larg
e
ye
ar
to
ye
ar
flu
ctu
atio
ns i
n h
ospital
adm
issio
ns f
or
pe
rtu
ssis
in
in
fants
age
d <
1 y
ea
r in
all
DH
Bs.
Duri
ng
20
06
–20
10
, adm
issio
ns w
ere
lo
we
r th
an
th
e N
ew
Ze
ala
nd
ra
te
in N
els
on
Ma
rlb
oro
ug
h,
Cante
rbu
ry,
Ota
go
an
d S
outh
lan
d,
alth
ou
gh
on
ly i
n
Can
terb
ury
did
th
ese
diffe
ren
ce
s r
each
sta
tistica
l sig
nific
ance
. S
ma
ll n
um
be
rs
pre
clu
ded
a v
alid
co
mp
ari
so
n in
th
e W
est C
oast
and
So
uth
Ca
nte
rbu
ry.
Me
nin
go
coccal
Dis
ease
In N
ew
Ze
ala
nd
, ho
spita
l a
dm
issio
ns f
or
me
nin
go
cocca
l dis
ease
in
child
ren
an
d y
ou
ng
pe
op
le d
eclin
ed
ra
pid
ly d
uri
ng
the
ea
rly-m
id 2
00
0s,
bu
t b
ecam
e
mo
re sta
tic a
fte
r 2
006
–07
. S
imila
r p
atte
rns w
ere
se
en
fo
r m
ort
alit
y d
urin
g
20
00
–2
008
, a
ltho
ugh
th
e n
um
be
r o
f d
ea
ths i
n 2
00
8 w
as h
igh
er
tha
n i
n t
he
pre
vio
us f
ou
r ye
ars
. A
dm
issio
ns a
nd
mort
alit
y w
ere
bo
th h
igh
est
for
infa
nts
<1
ye
ar.
Duri
ng
200
6–2
01
0,
ad
mis
sio
ns w
ere
als
o s
ign
ific
an
tly h
igh
er
for
ma
les,
Pa
cific
a
nd M
āo
ri>
Eu
rop
ea
n >
Asia
n/I
ndia
n child
ren
a
nd yo
un
g p
eop
le a
nd
tho
se
fro
m m
ore
de
pri
ve
d (
NZ
Dep
decile
5–1
0)
are
as.
In t
he
So
uth
Isla
nd d
urin
g 2
000
–2
010
, ho
spita
l a
dm
issio
ns f
or
men
ingo
cocca
l d
isea
se
in
ch
ildre
n a
nd
yo
ung
pe
ople
decre
ased
in
all D
HB
s.
Duri
ng
20
06
–2
01
0,
adm
issio
ns
we
re
sig
nific
an
tly
low
er
tha
n
the
N
ew
Z
ea
land
ra
te
in
Nels
on
M
arl
bo
rou
gh
a
nd
Can
terb
ury
, w
hile
in
S
ou
thla
nd
ra
tes
we
re
sig
nific
an
tly h
ighe
r. In
th
e W
est
Coast,
S
ou
th C
ante
rbu
ry a
nd
O
tag
o ra
tes
we
re n
ot
sig
nific
an
tly d
iffe
ren
t fr
om
th
e N
ew
Ze
ala
nd
ra
te.
Tu
be
rcu
losis
In N
ew
Ze
ala
nd
, h
ospita
l a
dm
issio
ns f
or
tub
erc
ulo
sis
in
ch
ildre
n a
nd
yo
ung
pe
op
le d
eclin
ed
aft
er
200
2–
03,
alth
oug
h a
sm
all
upsw
ing
in
ra
tes w
as e
vid
en
t in
20
10
. D
uri
ng
200
6–2
01
0,
ad
mis
sio
ns w
ere
hig
hest
am
on
gst
tho
se
in
the
ir
late
te
ens
an
d
ea
rly
twe
ntie
s.
Rate
s
we
re
als
o
sig
nific
an
tly
hig
he
r fo
r A
sia
n/I
ndia
n,
Pacific
an
d M
āo
ri c
hild
ren
an
d y
ou
ng
pe
op
le t
ha
n f
or
Eu
rop
ean
ch
ildre
n a
nd
yo
ung
pe
ople
and
fo
r th
ose f
rom
mo
re d
ep
rive
d (
NZ
Dep d
ecile
5
–1
0)
are
as.
In t
he
Sou
th I
sla
nd d
uri
ng 2
000
–2
010
, sm
all
num
bers
mad
e t
ren
ds in
ho
spital
ad
mis
sio
ns f
or
tub
erc
ulo
sis
in c
hild
ren
an
d y
ou
ng
pe
ople
difficult t
o i
nte
rpre
t.
Duri
ng
20
06
–2
010
, w
hile
adm
issio
ns w
ere
lo
we
r th
an
th
e N
ew
Ze
ala
nd
ra
te in
Nels
on
M
arl
bo
rou
gh
a
nd
C
an
terb
ury
, in
ne
ithe
r case
d
id th
ese
d
iffe
ren
ces
rea
ch
sta
tistical
sig
nific
an
ce
. S
ma
ll nu
mb
ers
pre
clu
ded
a va
lid a
naly
sis
in
S
ou
th C
an
terb
ury
an
d O
tag
o,
wh
ile t
he
re w
ere
no
ad
mis
sio
ns f
or
tube
rculo
sis
in
West
Coast o
r S
ou
thla
nd
child
ren
and
yo
un
g p
eop
le d
uri
ng
th
is p
erio
d.
Intr
odu
ctio
n a
nd
Ove
rvie
w -
38
Ind
ica
tor
New
Ze
ala
nd
Dis
trib
utio
n a
nd
Tre
nd
s
So
uth
Isla
nd
Dis
trib
utio
n a
nd
Tre
nd
s
Acu
te R
he
um
atic
Fe
ve
r a
nd
Rh
eum
atic
Hea
rt D
ise
ase
In N
ew
Ze
ala
nd
, h
osp
ital a
dm
issio
ns f
or
ch
ildre
n a
nd
yo
un
g p
eo
ple
with
acu
te
rhe
um
atic f
eve
r d
eclin
ed g
radu
ally
du
ring
the
ea
rly-m
id 2
000
s,
bu
t in
cre
ase
d
ag
ain
aft
er
200
6–
07
. In
con
tra
st,
ad
mis
sio
ns f
or
tho
se
with
rh
eum
atic h
ea
rt
dis
ea
se
we
re r
ela
tive
ly s
tatic d
uri
ng
th
e m
id-2
00
0s,
alth
ou
gh
a d
ow
nsw
ing
in
rate
s w
as e
vid
en
t in
2
010
. D
uri
ng 2
006
–20
10
, acu
te rh
eu
matic fe
ve
r a
nd
he
art
d
ise
ase
ad
mis
sio
ns
we
re
infr
equ
en
t d
urin
g
infa
ncy,
bu
t in
cre
ased
rap
idly
du
rin
g c
hild
ho
od
, to
re
ach
a p
ea
k a
t 1
1-1
2 y
ea
rs.
Acu
te r
he
um
atic
feve
r a
dm
issio
ns
we
re
sig
nific
an
tly
hig
he
r fo
r m
ale
s,
Pa
cific
>
M
āo
ri
>
Eu
rop
ean
an
d
Asia
n/I
nd
ian
ch
ildre
n
and
yo
ung
p
eo
ple
a
nd
th
ose
fr
om
a
ve
rag
e-t
o-m
ore
d
ep
rive
d
(NZ
Dep
d
ecile
3
–1
0)
are
as.
Rhe
um
atic
he
art
d
isea
se
a
dm
issio
ns
we
re
sig
nific
antly
hig
he
r fo
r fe
ma
les,
Pa
cific
>M
āo
ri
>E
uro
pea
n>
Asia
n/I
ndia
n c
hild
ren
and
yo
ung
pe
ople
an
d t
hose
fro
m a
ve
rag
e-
to-m
ore
dep
rive
d (
NZ
Dep
decile
3–1
0)
are
as.
In C
an
terb
ury
an
d O
tago
du
rin
g 2
006
–20
10
, ho
sp
ital
adm
issio
ns f
or
ch
ildre
n
an
d y
ou
ng
peo
ple
with
acu
te r
he
um
atic f
eve
r a
nd
rh
eum
atic h
eart
dis
ease
we
re s
ignific
an
tly l
ow
er
than
th
e N
ew
Ze
ala
nd
ra
te,
wh
ile i
n t
he W
est
Coa
st
no
ad
mis
sio
ns f
or
eith
er
ou
tco
me
occu
rred
du
ring
this
pe
rio
d,
an
d i
n S
ou
th
Can
terb
ury
sm
all
nu
mb
ers
p
reclu
ded
a
va
lid
an
aly
sis
. R
he
um
atic
he
art
d
isea
se
adm
issio
ns
in
Nels
on
M
arl
bo
rou
gh
an
d
So
uth
lan
d
we
re
als
o
sig
nific
an
tly
low
er
tha
n
the
N
ew
Z
ea
lan
d
rate
, alth
ou
gh
sm
all
num
be
rs
pre
clu
ded
a v
alid
an
aly
sis
fo
r a
cu
te r
heu
matic f
eve
r.
Se
rio
us S
kin
In
fectio
ns
In
New
Z
ea
lan
d
du
rin
g
20
00
–2
010
, h
osp
ital
ad
mis
sio
ns
for
se
rio
us
skin
in
fection
s i
ncre
ase
d i
n b
oth
ch
ildre
n a
nd y
ou
ng p
eop
le.
Du
rin
g 2
006
–20
10
, ce
llulit
is
an
d
cu
tan
eou
s
abscesse
s/fu
runcle
s/c
arb
un
cle
s
we
re
the
m
ost
fre
qu
en
t p
rim
ary
dia
gn
ose
s i
n c
hild
ren
adm
itte
d w
ith
se
rious s
kin
in
fectio
ns,
wh
ile
in
yo
un
g
peo
ple
, cuta
ne
ou
s
abscesse
s/fu
runcle
s/c
arb
un
cle
s
and
ce
llulit
is w
ere
th
e m
ain
re
ason
s f
or
adm
issio
n.
Ad
mis
sio
ns w
ere
hig
hest
in
infa
nts
<1
ye
ar,
with
a s
eco
nd
, sm
alle
r p
eak e
vid
ent
am
ong
st
those
in
th
eir
late
te
en
s a
nd
ea
rly t
we
ntie
s.
Ad
mis
sio
ns in
ch
ildre
n w
ere
sig
nific
antly h
ighe
r fo
r m
ale
s,
Pacific
> M
āo
ri >
Eu
rop
ean
an
d A
sia
n/In
dia
n c
hild
ren
an
d t
ho
se
fro
m
ave
rage
-to
-mo
re
dep
rive
d
(NZ
Dep
d
ecile
3
–1
0)
are
as.
Fo
r yo
ung
pe
op
le,
adm
issio
ns w
ere
sig
nific
an
tly h
ighe
r fo
r P
acific
an
d M
āo
ri >
Eu
rop
ea
n
>
Asia
n/I
ndia
n
yo
un
g
pe
op
le
an
d
tho
se
fr
om
a
ve
rage
-to
-mo
re
de
prive
d
(NZ
Dep
decile
3–1
0)
are
as.
In t
he
Sou
th I
sla
nd
du
rin
g 2
00
0–
201
0,
ho
spital
adm
issio
ns f
or
se
rio
us s
kin
in
fection
s
in
ch
ildre
n
an
d
you
ng
p
eo
ple
in
cre
ase
d
in
all
DH
Bs,
with
th
e
exce
ptio
n o
f th
e W
est
Coa
st, w
he
re a
dm
issio
ns i
n y
ou
ng
pe
op
le d
eclin
ed
, w
hile
a
dm
issio
ns in
ch
ildre
n flu
ctu
ate
d.
Duri
ng
2
00
6–
201
0,
ad
mis
sio
ns in
ch
ildre
n w
ere
sig
nific
an
tly lo
we
r th
an
the
New
Ze
ala
nd
ra
te in
all
So
uth
Isla
nd
DH
Bs.
While
a
dm
issio
ns fo
r yo
un
g p
eop
le w
ere
a
lso
lo
wer
tha
n th
e N
ew
Z
ea
lan
d r
ate
, o
nly
in
Can
terb
ury
, S
ou
th C
an
terb
ury
, O
tag
o a
nd
So
uth
land
did
th
ese
d
iffe
ren
ces
rea
ch
sta
tistica
l sig
nific
an
ce.
In
Ca
nte
rbu
ry,
adm
issio
ns
we
re h
igh
er
for
Pa
cific
> M
āo
ri a
nd
Eu
rop
ea
n >
Asia
n/Ind
ian
ch
ildre
n a
nd
yo
un
g
pe
op
le,
altho
ug
h
in
the
W
est
Coa
st
an
d
Sou
th
Can
terb
ury
n
o
co
nsis
ten
t e
thn
ic d
iffe
ren
ce
s w
ere
se
en
. In
Nels
on M
arl
bo
rou
gh a
dm
issio
ns
we
re
hig
he
r fo
r M
āo
ri
tha
n
for
Eu
rop
ean
ch
ildre
n
and
yo
un
g
pe
op
le
thro
ugh
ou
t 2
000
–2
01
0,
wh
ile in
Ota
go
, a
dm
issio
ns w
ere
hig
he
r fr
om
200
4–
05
on
wa
rds,
and
in S
ou
thla
nd
ra
tes w
ere
hig
he
r du
ring
200
8–10
.
Ga
str
oe
nte
ritis
In N
ew
Z
ea
lan
d,
ga
str
oe
nte
ritis a
dm
issio
ns in
cre
ase
d g
rad
ua
lly d
uri
ng
th
e
ea
rly-m
id 2
00
0s b
ut
be
ca
me s
tatic a
fte
r 2
00
6-0
7 i
n b
oth
ch
ildre
n a
nd y
ou
ng
pe
op
le.
Duri
ng
20
02
–20
08
, on
ave
rag
e o
ne
child
or
yo
ung p
ers
on
pe
r ye
ar
die
d
from
ga
str
oe
nte
ritis.
Duri
ng
2
006
–2
01
0,
adm
issio
ns
we
re
hig
he
st
in
infa
nts
<
1 ye
ar,
w
ith
ra
tes ta
pe
rin
g o
ff ra
pid
ly d
uri
ng th
e p
resch
ool
ye
ars
. M
ort
alit
y w
as a
lso
h
igh
est
in in
fan
ts <
1 ye
ar.
A
dm
issio
ns in
ch
ildre
n w
ere
sig
nific
an
tly h
ighe
r fo
r m
ale
s,
Pa
cific
> A
sia
n/In
dia
n a
nd
Eu
rop
ean
> M
āo
ri
ch
ildre
n
and
th
ose
from
a
ve
rag
e-t
o-m
ore
de
pri
ve
d
(NZ
Dep
d
ecile
4
–1
0)
are
as.
In c
on
trast,
ad
mis
sio
ns i
n y
ou
ng p
eop
le w
ere
sig
nific
an
tly h
igh
er
for
fem
ale
s,
Eu
rop
ean
>
P
acific
a
nd
M
āo
ri >
A
sia
n/In
dia
n yo
un
g p
eop
le,
and
tho
se
fro
m a
ve
rage
-to
-mo
re d
ep
rive
d (
NZ
Dep
decile
4–
10
) are
as.
Duri
ng
2
00
6–2
01
0,
ga
str
oe
nte
ritis a
dm
issio
ns in
child
ren
w
ere
sig
nific
an
tly
low
er
tha
n th
e N
ew
Z
ea
lan
d ra
te in
a
ll o
f th
e S
ou
th Is
lan
d D
HB
s e
xce
pt
So
uth
lan
d,
wh
ere
ad
mis
sio
ns w
ere
sig
nific
an
tly h
igh
er.
Adm
issio
ns i
n y
ou
ng
pe
op
le w
ere
sig
nific
an
tly lo
we
r th
an
the
New
Ze
ala
nd
ra
te in
th
e W
est
Coast,
Can
terb
ury
, a
nd
S
ou
thla
nd
, w
hile
ra
tes
in
Nels
on
Ma
rlb
oro
ug
h,
So
uth
C
an
terb
ury
an
d O
tago
we
re n
ot
sig
nific
antly d
iffe
ren
t fr
om
th
e N
ew
Ze
ala
nd
rate
. In
C
ante
rbu
ry,
adm
issio
ns
we
re
ge
ne
rally
hig
he
r fo
r E
uro
pe
an
and
Pa
cific
> M
āo
ri a
nd
Asia
n/I
ndia
n c
hild
ren a
nd y
ou
ng
peo
ple
, w
hile
in
Nels
on
Ma
rlb
oro
ug
h,
the
West
Coa
st,
O
tag
o a
nd
S
ou
thla
nd ra
tes w
ere
h
igh
er
for
Eu
rop
ean
th
an
fo
r M
āo
ri ch
ildre
n an
d yo
un
g p
eo
ple
. E
thn
ic d
iffe
rences in
S
ou
th
Can
terb
ury
w
ere
le
ss
co
nsis
ten
t.
Adm
issio
ns
we
re
als
o
ge
ne
rally
h
igh
er
in s
prin
g a
nd
ea
rly s
um
me
r in
all
DH
Bs.
Intr
odu
ctio
n a
nd
Ove
rvie
w -
39
Ind
ica
tor
New
Ze
ala
nd
Dis
trib
utio
n a
nd
Tre
nd
s
So
uth
Isla
nd
Dis
trib
utio
n a
nd
Tre
nd
s
Oth
er
Issu
es
Inju
rie
s in
Child
ren
In N
ew
Ze
ala
nd d
urin
g 2
00
6–
20
10
fa
lls,
follo
we
d b
y i
na
nim
ate
mech
anic
al
forc
es w
ere
th
e le
ad
ing
ca
use
s o
f in
jury
ad
mis
sio
ns in
ch
ildre
n,
alth
oug
h
tra
nsp
ort
inju
rie
s a
s a
gro
up
als
o m
ad
e a
sig
nific
an
t co
ntr
ibu
tio
n.
In c
ontr
ast,
accid
enta
l th
rea
ts t
o b
rea
thin
g,
follo
we
d b
y v
ehic
le o
ccu
pan
t in
juri
es w
ere
th
e
lea
din
g c
ause
s o
f child
ho
od
in
jury
mo
rta
lity d
urin
g 2
00
4–
20
08
. D
urin
g 2
00
0–
20
08
, m
ort
alit
y fr
om
la
nd
tr
an
sp
ort
in
jurie
s a
nd u
nin
tention
al
no
n-t
ran
sp
ort
in
jurie
s in
ch
ildre
n b
oth
d
eclin
ed
, w
hile
m
ort
alit
y fr
om
accid
en
tal
thre
ats
to
bre
ath
ing
in
cre
ase
d.
Th
e m
ajo
rity
of
accid
enta
l th
rea
ts t
o b
rea
thin
g d
ea
ths
ho
we
ve
r, o
ccu
rred
in
in
fants
<1
ye
ar,
wh
o w
ere
co
ded
as d
yin
g a
s a
re
su
lt o
f su
ffoca
tio
n/s
tran
gula
tio
n i
n b
ed
, an
d t
hus th
e po
tential
exis
ts fo
r so
me th
e
incre
ases s
een
to
ha
ve
arise
n fro
m a
dia
gn
ostic s
hift in
th
e c
od
ing o
f S
UD
I.
In t
he
Sou
th I
sla
nd
du
rin
g 2
006
–2
010
fa
lls,
follo
we
d b
y in
anim
ate
me
cha
nic
al
forc
es,
we
re t
he
le
adin
g c
ause
s o
f in
jury
ad
mis
sio
ns i
n c
hild
ren
in
all
DH
Bs,
alth
ou
gh
tra
nsp
ort
inju
rie
s a
s a
gro
up
als
o m
ad
e a
sig
nific
an
t co
ntr
ibu
tio
n.
Duri
ng
2
00
4–2
00
8,
accid
enta
l th
rea
ts
to
bre
ath
ing
, ve
hic
le
occup
an
t,
pe
destr
ian
an
d o
the
r tr
an
spo
rt i
nju
ries,
an
d a
ssa
ults w
ere
am
on
g t
he
le
ad
ing
ca
use
s o
f in
jury
mo
rtalit
y in S
ou
th Isla
nd
ch
ildre
n.
Ora
l H
ea
lth
Sch
ool
Den
tal
Se
rvic
e D
ata
: In
N
ew
Z
ea
lan
d d
urin
g 2
00
0–
20
10,
the
%
of
ch
ildre
n ca
ries-f
ree a
t 5 ye
ars
w
as hig
he
r in
a
rea
s w
ith
flu
ori
date
d sch
oo
l w
ate
r su
pplie
s,
wh
ile m
ea
n D
MF
T sco
res a
t 12
ye
ars
w
ere
lo
we
r. D
urin
g
20
03
–2
010
, a
h
igh
er
% o
f E
uro
pe
an
/Oth
er
ch
ildre
n,
than M
āo
ri o
r P
acific
ch
ildre
n w
ere
ca
ries-f
ree
at
5 y
ea
rs,
wh
ile m
ea
n D
MF
T s
co
res a
t 1
2 y
ea
rs
we
re h
igh
er
for
Mā
ori
an
d P
acific
ch
ildre
n t
han
fo
r E
uro
pe
an
/Oth
er
child
ren
.
Den
tal
Carie
s A
dm
issio
ns:
In N
ew
Ze
ala
nd
du
ring
20
06
–2
01
0,
de
nta
l ca
ries
we
re th
e le
ad
ing
re
aso
ns fo
r d
en
tal
ad
mis
sio
ns in
child
ren
0
–4 a
nd
5–
14
ye
ars
. In
co
ntr
ast,
e
mb
ed
ded
/im
pa
cte
d te
eth
w
ere
th
e le
ad
ing
re
aso
ns in
yo
un
g p
eo
ple
15–
24
ye
ars
.
Den
tal
ca
rie
s a
dm
issio
ns i
n c
hild
ren
0–
4 y
ea
rs w
ere
sig
nific
an
tly h
igh
er
for
ma
les,
Pacific
> M
āo
ri >
Asia
n/I
ndia
n >
Eu
rope
an
ch
ildre
n a
nd
tho
se
fro
m
ave
rag
e-t
o-m
ore
de
pri
ve
d (
NZ
De
p d
ecile
2–
10
) a
rea
s,
wh
ile a
dm
issio
ns f
or
ch
ildre
n 5
–14
ye
ars
we
re s
ign
ific
an
tly h
igh
er
for
ma
les,
Mā
ori
an
d P
acific
>
Asia
n/I
ndia
n a
nd
Eu
rop
ean
child
ren
an
d t
ho
se
fro
m a
ve
rag
e-t
o-m
ore
de
prive
d
(NZ
Dep
de
cile
3–1
0)
are
as.
Fo
r yo
un
g p
eo
ple
15
–2
4 y
ea
rs,
ad
mis
sio
ns w
ere
sig
nific
an
tly h
igh
er
for
Eu
rope
an
an
d M
āo
ri >
Pa
cific
> A
sia
n/I
ndia
n y
oun
g
pe
op
le a
nd
tho
se f
rom
mo
re d
ep
rive
d (
NZ
Dep
decile
5–
10
) are
as.
Sch
ool
Den
tal
Se
rvic
e D
ata
: In
th
e S
ou
the
rn D
HB
du
rin
g 2
01
0,
49
.5%
of
5
ye
ar
old
s e
xa
min
ed
by t
he
Sch
ool
De
nta
l S
erv
ice
ha
d a
cce
ss t
o f
luo
rida
ted
Sch
ool
wa
ter,
a
s
com
pa
red
to
0.6
%
in
Can
terb
ury
a
nd
0
%
in
Nels
on
Ma
rlb
oro
ug
h,
So
uth
Ca
nte
rbu
ry a
nd
the
West
Coa
st. I
n a
ll S
ou
th I
sla
nd
DH
Bs
du
rin
g 2
00
3–
20
09
, a
hig
he
r p
rop
ort
ion
of
Eu
rop
ea
n/O
the
r child
ren
th
an
Mā
ori
ch
ildre
n w
ere
ca
ries-f
ree
at
5 y
ea
rs,
wh
ile m
ea
n D
MF
T s
co
res a
t 1
2 y
ea
rs
we
re
hig
he
r fo
r M
āo
ri,
tha
n
for
Eu
rop
ean
/Oth
er
child
ren
. In
N
els
on
Ma
rlb
oro
ug
h d
urin
g 2
00
9,
80
.4%
of
elig
ible
ad
ole
scen
ts (
age
d ≈
13
–18
ye
ars
) w
ere
re
po
rted
as a
cce
ssin
g p
ub
licly
fun
de
d d
en
tal
se
rvic
es,
as c
om
pa
red t
o
76
.5%
in
th
e W
est
Coast,
67
.1%
in
Can
terb
ury
, 8
8.1
% i
n S
ou
th C
an
terb
ury
, 8
3.7
% in
Ota
go
an
d 7
3.7
% in
So
uth
lan
d.
Den
tal
Carie
s
Ad
mis
sio
ns:
Du
rin
g 2
00
6–2
010
, d
enta
l ca
ries w
as th
e
lea
din
g r
easo
n f
or
a d
en
tal
adm
issio
n i
n c
hild
ren
age
d 0
–4
an
d 5
–1
4
ye
ars
in
all
So
uth
Isla
nd
DH
Bs,
wh
ile e
mb
ed
de
d/
imp
acte
d t
eeth
or
den
tal
ca
rie
s
we
re
the
lea
din
g
reaso
ns
for
adm
issio
ns
in
yo
un
g
peo
ple
1
5–2
4
ye
ars
. In
S
outh
land
, h
osp
ita
l a
dm
issio
ns
for
den
tal
ca
ries in
ch
ildre
n 0
–4
an
d 5
–1
4 y
ea
rs a
nd
yo
ung
peo
ple
15–
24 y
ears
w
ere
sig
nific
antly h
ighe
r th
an t
he N
ew
Ze
ala
nd
ra
te.
In a
ll o
f th
e o
ther
So
uth
Isla
nd
DH
Bs h
ow
eve
r, n
o c
onsis
tent
patt
ern
s w
ere
se
en
, w
ith
a
dm
issio
ns in
so
me
a
ge
g
rou
ps b
ein
g sig
nific
antly h
igh
er
tha
n th
e
Ne
w Z
ea
lan
d r
ate
, w
hile
in
oth
ers
ra
tes w
ere
sim
ilar
or
sig
nific
antly
low
er.
Intr
odu
ctio
n a
nd
Ove
rvie
w -
40
Ind
ica
tor
New
Ze
ala
nd
Dis
trib
utio
n a
nd
Tre
nd
s
So
uth
Isla
nd
Dis
trib
utio
n a
nd
Tre
nd
s
Pe
rma
ne
nt
Hea
ring
L
oss
Dea
fness
Notifica
tio
n
Data
ba
se:
In
New
Z
ea
land
du
rin
g
20
10
, 1
20
no
tificatio
ns w
ere
re
ce
ive
d b
y t
he
Dea
fness N
otifica
tio
n D
ata
ba
se
fo
r ch
ildre
n
with
bila
tera
l h
ea
rin
g l
osse
s o
f >
26
dB
in
th
e b
ette
r e
ar
and
60
no
tifica
tion
s
we
re r
ece
ive
d f
or
ch
ildre
n w
ith u
nila
tera
l lo
sses.
Duri
ng
20
10,
15
% o
f ch
ildre
n
no
tifie
d t
o t
he
DN
D h
ad
pro
fou
nd
losse
s,
6%
had
se
ve
re l
osses,
37
% h
ad
mo
de
rate
lo
sse
s a
nd
42
% ha
d m
ild lo
sse
s.
When
u
nila
tera
l, acq
uire
d an
d
ove
rse
as b
orn
cases w
ere
exclu
de
d,
the
ave
rag
e a
ge
at
co
nfirm
atio
n o
f a
he
ari
ng
loss i
n 2
01
0 w
as 5
1 m
on
ths,
alth
ou
gh
the
ave
rag
e a
ge
of
susp
icio
n
wa
s m
uch e
arlie
r (3
1 m
on
ths).
New
bo
rn
Hea
rin
g
Scre
en
ing:
In
New
Z
ea
lan
d
du
ring
1
A
pri
l 2
010
–30
Se
pte
mb
er
20
10
, th
e ca
reg
ive
rs o
f 7
7.8
% o
f e
ligib
le b
ab
ies co
nse
nte
d to
n
ew
bo
rn h
ea
ring
scre
enin
g,
alth
ou
gh
th
i s p
rop
ort
ion
va
ried
by D
HB
. O
f th
ose
co
mp
letin
g s
cre
enin
g 9
4.0
% d
id s
o w
ith
in o
ne
mo
nth
, w
ith
2.4
% o
f b
ab
ies
co
mp
letin
g s
cre
enin
g re
ceiv
ing
a
n au
dio
log
y re
ferr
al. O
f th
ose
ba
bie
s w
ho
p
asse
d
scre
enin
g,
a
furt
he
r 7
.4%
w
ere
d
ee
me
d
to
ha
ve
risk
facto
rs
for
de
laye
d o
nse
t/p
rog
ressiv
e h
eari
ng
lo
ss w
hic
h w
arr
an
ted
follo
w u
p o
ve
r tim
e.
Dea
fness N
otifica
tio
n D
ata
base
: In
th
e S
ou
th Is
land
D
HB
s d
urin
g 2
01
0,
a
tota
l o
f 49
ch
ildre
n w
ere
notified
to
the
De
afn
ess N
otifica
tio
n D
ata
base
.
New
bo
rn H
ea
rin
g S
cre
en
ing
: In
th
e S
ou
th I
sla
nd D
HB
s (
exclu
din
g S
ou
the
rn
DH
B
wh
ere
h
ea
rin
g scre
en
ing
co
mm
ence
d p
art
w
ay th
rou
gh
th
e p
erio
d),
n
ew
bo
rn h
ea
rin
g s
cre
en
ing c
on
sen
t ra
tes r
ang
ed
fro
m 6
0.8
% t
o 9
8.7
%,
with
the
pro
po
rtio
n o
f b
ab
ies b
ein
g r
efe
rre
d f
or
au
dio
log
y a
sse
ssm
en
t ra
ng
ing
fro
m
0%
to 2
.1%
an
d t
he p
rop
ort
ion b
ein
g t
arg
ete
d f
or
follo
w u
p r
an
gin
g f
rom
4.4
%
to 1
0.4
%.
Issue
s M
ore
Co
mm
on in
Yo
ung
Pe
ople
To
tal a
nd
Avoid
able
Mo
rbid
ity a
nd
Mo
rta
lity
Mo
st
Fre
qu
en
t C
au
ses o
f H
ospita
l A
dm
issio
ns a
nd
M
ort
alit
y
In
New
Z
ea
land
d
urin
g
200
6–
201
0,
issu
es
associa
ted
with
p
reg
nan
cy,
de
live
ry
an
d
the
p
ostn
ata
l pe
rio
d
we
re
the
le
ad
ing
re
aso
ns
for
ho
spital
ad
mis
sio
n
in
yo
un
g
pe
ople
. In
te
rms
of
oth
er
ad
mis
sio
n
typ
es,
inju
ry/p
ois
on
ing
an
d a
bd
om
inal/p
elv
ic p
ain
we
re t
he
le
ad
ing
re
ason
s f
or
acu
te
ad
mis
sio
ns,
inju
ry/p
ois
on
ing
a
nd
n
eo
pla
sm
s/c
hem
oth
era
py/r
ad
ioth
era
py th
e
lea
din
g
rea
son
s
for
arr
ang
ed
a
dm
issio
ns,
an
d
muscu
loske
leta
l an
d
ga
str
oin
testin
al
pro
ce
du
res th
e le
ad
ing
re
ason
s fo
r w
aitin
g lis
t a
dm
issio
ns.
Duri
ng
20
04
–2
008
, in
ten
tio
nal
se
lf-h
arm
, ve
hic
le o
ccu
pa
nt
tra
nsp
ort
in
juries
an
d n
eo
pla
sm
s w
ere
th
e l
ead
ing
cau
ses o
f m
ort
alit
y i
n y
ou
ng
pe
op
le a
ged
15
–2
4 y
ea
rs.
In th
e S
ou
th Is
land
d
urin
g 20
06
–20
10
, is
su
es a
ssocia
ted w
ith
p
reg
na
ncy,
de
live
ry
an
d
the
p
ostn
ata
l pe
rio
d
we
re
the
le
ad
ing
re
aso
ns
for
ho
spital
ad
mis
sio
ns i
n y
oun
g p
eo
ple
in
all
DH
Bs.
In t
erm
s o
f o
the
r a
dm
issio
n t
yp
es,
inju
ry/p
ois
on
ing
, m
en
tal
he
alth
is
su
es an
d ab
dom
ina
l/pe
lvic
p
ain
w
ere
th
e
lea
din
g
rea
so
ns
for
acu
te
adm
issio
ns.
Inju
ry/p
ois
on
ing
, n
eop
lasm
/ ch
em
oth
era
py/r
adio
the
rap
y,
me
nta
l h
ealth
is
su
es,
dia
lysis
a
nd
d
en
tal
co
nditio
ns
we
re
fre
qu
ent
rea
so
ns
for
arr
an
ge
d
ad
mis
sio
ns,
wh
ile
ga
str
oin
testin
al,
muscu
loske
leta
l,
an
d
skin
p
roce
du
res,
ton
sill
ecto
my
+/−
a
de
noid
ecto
my a
nd
de
nta
l p
roce
du
res w
ere
fre
qu
en
t re
ason
s f
or
wa
itin
g l
ist
ad
mis
sio
ns.
Durin
g 2
004
–2
00
8,
inte
ntio
na
l se
lf-h
arm
a
nd ve
hic
le occu
pa
nt
tra
nsp
ort
in
juries w
ere
th
e le
ad
ing
ca
uses o
f m
ort
alit
y in
yo
un
g p
eo
ple
.
Oth
er
Issu
es
Inju
rie
s in
Yo
un
g
Pe
op
le
In N
ew
Z
ea
lan
d du
ring
20
06
–2
01
0,
ina
nim
ate
m
ech
an
ical
forc
es a
nd
fa
lls
we
re t
he
le
ad
ing
cau
se
s o
f in
jury
ad
mis
sio
ns i
n y
ou
ng
pe
ople
, a
lth
oug
h a
s a
g
rou
p
tra
nsp
ort
in
jurie
s
als
o
ma
de
a
sig
nific
an
t con
trib
utio
n.
In
con
tra
st,
du
rin
g 2
004
–2
00
8,
inte
ntio
na
l se
lf-h
arm
an
d v
eh
icle
occu
pa
nt
inju
rie
s w
ere
th
e le
ad
ing
ca
use
s o
f in
jury
re
late
d m
ort
alit
y.
In t
he
Sou
th I
sla
nd
du
rin
g 2
00
6–
201
0,
ina
nim
ate
me
ch
an
ica
l fo
rce
s a
nd
fa
lls
we
re a
lso
th
e l
ead
ing
ca
uses o
f in
jury
ad
mis
sio
ns i
n y
oun
g p
eo
ple
, a
lth
ou
gh
as a
gro
up
tra
nspo
rt inju
rie
s a
ga
in m
ad
e a
sig
nific
an
t co
ntr
ibu
tio
n.
In c
on
trast,
du
rin
g 2
004
–2
00
8,
inte
ntio
na
l se
lf-h
arm
an
d v
eh
icle
occu
pa
nt
inju
rie
s w
ere
th
e le
ad
ing
ca
use
s o
f in
jury
re
late
d m
ort
alit
y.
Intr
odu
ctio
n a
nd
Ove
rvie
w -
41
Ind
ica
tor
New
Ze
ala
nd
Dis
trib
utio
n a
nd
Tre
nd
s
So
uth
Isla
nd
Dis
trib
utio
n a
nd
Tre
nd
s
Te
en
ag
e P
reg
na
ncy
In N
ew
Ze
ala
nd
, te
en
age
liv
e b
irth
s d
eclin
ed
du
ring
th
e l
ate
19
90
s a
nd e
arly
20
00s,
to r
each
th
eir
lo
we
st
po
int
in 2
00
2.
Bir
th r
ate
s t
he
n g
rad
ua
lly in
cre
ased
ag
ain
, re
ach
ing
a
pe
ak
of
32
.4
pe
r 1
,00
0
in
200
8.
In
co
ntr
ast,
te
en
ag
e
term
ina
tio
ns in
cre
ase
d d
urin
g th
e la
te 1
990
s a
nd
e
arl
y 20
00
s,
reach
ed
a
pla
tea
u d
urin
g 2
002
–2
00
7,
an
d th
en
d
eclin
ed
, w
ith
te
en
ag
e liv
e b
irth
a
nd
term
ina
tio
n r
ate
s b
ein
g r
ou
ghly
eq
uiv
ale
nt
du
rin
g 2
002
–20
04
.
Duri
ng
20
06–
201
0,
tee
na
ge
liv
e b
irth
ra
tes w
ere
sig
nific
an
tly h
igh
er
for
Mā
ori
> P
acific
> E
uro
pea
n >
Asia
n/In
dia
n w
om
en
an
d t
ho
se
fro
m a
ve
rag
e-t
o-m
ore
d
ep
rive
d (
NZ
Dep
de
cile
2–1
0)
are
as.
Hig
he
r te
en
age
liv
e b
irth
ra
tes f
or
Mā
ori
a
nd
Pa
cific
wo
me
n h
ow
eve
r, m
ust
be
see
n i
n t
he
co
nte
xt
of
hig
he
r o
ve
rall
fert
ility
ra
tes (
at a
ll a
ges)
for
Mā
ori
an
d P
acific
wo
men
.
In S
outh
lan
d d
urin
g 2
006
–201
0,
tee
na
ge b
irth
ra
tes w
ere
sig
nific
an
tly h
igh
er
tha
n t
he
New
Ze
ala
nd
ra
te,
wh
ile i
n N
els
on
Ma
rlb
oro
ugh
, C
an
terb
ury
, a
nd
O
tag
o ra
tes w
ere
sig
nific
an
tly lo
we
r. R
ate
s in
th
e W
est
Coa
st
an
d S
ou
th
Can
terb
ury
w
ere
n
ot
sig
nific
an
tly d
iffe
ren
t fr
om
th
e N
ew
Z
ea
lan
d ra
te.
In
Can
terb
ury
, te
ena
ge b
irth
rate
s w
ere
hig
he
r fo
r M
āo
ri >
Pa
cific
> E
uro
pe
an
>
Asia
n/I
ndia
n w
om
en
, w
hile
in t
he
re
ma
inin
g S
ou
th I
sla
nd
DH
Bs,
rate
s w
ere
h
igh
er
for
Mā
ori
tha
n fo
r E
uro
pe
an
wo
me
n.
Te
rmin
atio
ns o
f P
reg
na
ncy
In N
ew
Ze
ala
nd
du
rin
g 1
98
0–2
01
0,
term
ina
tio
ns o
f p
regn
ancy w
ere
hig
he
st
in
wo
me
n a
ge
d 2
0-2
4 y
ea
rs,
follo
we
d b
y t
ho
se
25
-29
ye
ars
an
d 1
5-1
9 y
ea
rs.
Te
rmin
atio
n r
ate
s i
ncre
ased
du
rin
g t
he
19
80
s a
nd
199
0s,
with
ra
tes r
ea
ch
ing
a p
eak f
or
most
age
gro
up
s in
th
e e
arly 2
00
0s a
nd
the
n b
eg
inn
ing t
o g
rad
ually
d
eclin
e.
Durin
g 2
006
–20
10
, te
rmin
ation
s w
ere
hig
he
r fo
r P
acific
an
d M
āo
ri >
E
uro
pe
an
> A
sia
n t
een
age
rs,
wh
ile a
mo
ngst
those
20
–2
4 y
ea
rs,
term
ina
tion
s
we
re h
igh
er
for
Pacific
> M
āo
ri >
Asia
n a
nd
Eu
rop
ean
wo
men
.
Duri
ng
20
09,
a to
tal
of
3,5
50 te
rmin
atio
ns o
f p
regn
ancy w
ere
re
co
rded
as
occu
rrin
g
am
ong
st
wo
me
n
livin
g
in
the
S
ou
th
Isla
nd
’s
Reg
iona
l C
ou
ncil
ca
tch
me
nts
.
Th
e C
hild
ren
’s S
ocia
l H
ea
lth
Mo
nito
r
Eco
nom
ic I
nd
ica
tors
Gro
ss D
om
estic
Pro
du
ct
(GD
P)
In N
ew
Ze
ala
nd
, G
DP
de
cre
ase
d f
or
five
co
nse
cu
tive
qua
rte
rs f
rom
Ma
rch
2
00
8–
Ma
rch
20
09
, b
efo
re
incre
asin
g
ag
ain
, fo
r five
co
nse
cu
tive
q
ua
rte
rs,
fro
m
Jun
e
20
09–
Jun
e
20
10
. G
DP
th
en
brie
fly
de
clin
ed
by
0.1
%
in
the
Se
pte
mb
er
qu
art
er
of
20
10,
be
fore
in
cre
asin
g
ag
ain
, b
y
0.6
%
in
the
Dece
mb
er
20
10
qu
art
er,
by 0
.9%
in
th
e M
arc
h 2
011
qua
rter
an
d b
y 0
.1%
in
the
Jun
e 2
01
1 qu
art
er.
E
con
om
ic
activity fo
r th
e ye
ar
en
din
g Ju
ne
2
01
1
incre
ased
by 1
.5%
.
Incom
e In
eq
ua
lity
In N
ew
Ze
ala
nd
du
rin
g 1
98
4–
20
10
in
co
me
in
equ
alit
y,
as m
easu
red
by t
he
P8
0/P
20
ra
tio
an
d G
ini
co
effic
ien
t, w
as h
ighe
r a
fter
ad
justing
fo
r h
ousin
g
co
sts
tha
n p
rio
r to
th
is a
dju
stm
en
t. T
he
most
rapid
ris
es i
n i
ncom
e i
neq
ua
lity
occu
rre
d
be
twe
en
th
e
late
19
80
s
and
e
arly
19
90
s.
Durin
g
the
e
arl
y–
mid
2
00
0s h
ow
eve
r, i
ncom
e i
neq
ua
lity d
eclin
ed
, a c
ha
nge
Pe
rry a
ttrib
ute
s l
arg
ely
to
th
e W
ork
ing
fo
r F
am
ilie
s p
ackag
e.
Add
itio
nal fa
lls in incom
e in
eq
ua
lity w
ere
se
en i
n 2
01
0,
with
Pe
rry a
ttrib
uting
this
to a
fa
ll in
hig
he
r in
com
es,
co
uple
d
with
sm
all
gain
s f
or
low
er
incom
e h
ou
se
hold
s.
Intr
odu
ctio
n a
nd
Ove
rvie
w -
42
Ind
ica
tor
New
Ze
ala
nd
Dis
trib
utio
n a
nd
Tre
nd
s
So
uth
Isla
nd
Dis
trib
utio
n a
nd
Tre
nd
s
Child
Po
ve
rty a
nd
L
ivin
g S
tan
da
rds
In N
ew
Ze
ala
nd
du
ring
198
8–1
99
2, ch
ild p
ove
rty r
ate
s in
cre
ase
d m
ark
edly
, a
s
a r
esult o
f risin
g u
nem
plo
ym
en
t a
nd t
he
19
91
Be
nefit
cu
ts.
Duri
ng
19
94
–1
998
ho
we
ve
r,
rate
s
declin
ed
, a
s
econ
om
ic
co
nd
itio
ns
imp
rove
d
and
un
em
plo
ym
en
t fe
ll. D
urin
g 1
99
8–
200
4,
ch
ild p
ove
rty t
rend
s v
ari
ed
, d
ep
en
din
g
on
th
e
mea
su
re
use
d,
bu
t be
twe
en
2
00
4
and
2
00
7
the
y
ag
ain
d
eclin
ed,
follo
win
g t
he
ro
ll o
ut
of
the
Wo
rkin
g f
or
Fam
ilies p
ackag
e.
Fo
r th
e m
ajo
rity
of
this
pe
riod
, ch
ild p
ove
rty r
ate
s w
ere
hig
he
r fo
r yo
ung
er
ch
ildre
n (
0–
11
vs.
12–
17
ye
ars
), la
rge
r h
ouse
ho
lds (
3 o
r m
ore
child
ren
vs.
1–2
ch
ildre
n),
so
le p
are
nt
ho
use
hold
s a
nd
ho
use
hold
s w
he
re t
he
ad
ults w
ere
eith
er
wo
rkle
ss,
or
wh
ere
n
on
e w
ork
ed
fu
ll tim
e.
Une
mplo
ym
ent
Rate
s
In t
he
qu
art
er
en
din
g S
epte
mb
er
20
11
, se
aso
na
lly a
dju
ste
d u
nem
plo
ym
en
t ra
tes
rose
to
6
.6%
, w
hile
se
aso
nally
a
dju
ste
d
un
em
plo
ym
en
t n
um
be
rs
incre
ased
fr
om
15
4,0
00
to
1
57
,00
0.
Duri
ng
S
ep
tem
be
r 1
98
7–
201
1,
un
em
plo
ym
en
t ra
tes w
ere
hig
he
r fo
r yo
un
ge
r p
eo
ple
(1
5–
19
ye
ars
> 2
0–2
4
ye
ars
>
2
5–
29
ye
ars
>
3
5–
39
ye
ars
a
nd
4
5–
49
ye
ars
) an
d th
ose
w
ith
n
o
qu
alif
ica
tio
ns
>
sch
ool
qua
lific
atio
ns,
or
po
st
sch
oo
l b
ut
no
sch
oo
l q
ua
lific
atio
ns >
bo
th p
ost
sch
oo
l a
nd
sch
ool
qua
lific
ations,
alth
ou
gh
th
ere
w
ere
no
co
nsis
ten
t g
en
de
r d
iffe
ren
ce
s f
or
yo
un
g p
eo
ple
15
–2
4 y
ea
rs.
Durin
g
20
07
(Q4
)–2
011
(Q3
) un
em
plo
ym
en
t ra
tes w
ere
hig
he
r fo
r M
āo
ri a
nd
Pacific
>
Asia
n/I
ndia
n
>
Eu
rope
an
pe
op
le.
Unem
plo
ym
en
t ra
tes
incre
ased
fo
r all
eth
nic
gro
up
s d
uri
ng
20
08
and
20
09
, bu
t b
ecam
e m
ore
sta
tic d
uri
ng
20
10
–2
01
1(Q
3)
for
Mā
ori
, P
acific
a
nd
E
uro
pe
an
p
eop
le.
Rate
s fo
r A
sia
n/In
dia
n
pe
op
le d
eclin
ed
be
twe
en
20
10(Q
2)
an
d 2
01
1(Q
2).
In th
e S
outh
Is
lan
d d
urin
g 2
00
5(Q
1)–
20
11
(Q3
) u
nem
plo
ym
en
t tr
end
s w
ere
sim
ilar
to t
ho
se
occu
rrin
g n
atio
na
lly.
Rate
s f
luctu
ate
d d
uring
20
05
–2
00
8,
bu
t b
eg
an to
rise
t h
ere
afte
r. R
ate
s w
ere
lo
we
r th
an
th
e N
ew
Z
ea
lan
d ra
te in
C
an
terb
ury
, T
asm
an
/Nels
on/M
arl
bo
rou
gh
/West
Coa
st,
an
d
So
uth
land
thro
ugh
ou
t th
is
pe
rio
d,
wh
ile
in
Ota
go
rate
s
we
re
low
er
du
rin
g
20
08
-–2
01
1(Q
3).
Child
ren
Re
lian
t o
n
Be
ne
fit R
ecip
ien
ts
In N
ew
Ze
ala
nd
, th
e p
ropo
rtio
n o
f child
ren
ag
ed
0–
18
ye
ars
wh
o w
ere
re
lian
t o
n a
be
ne
fit,
or
be
ne
fit
recip
ien
t, f
ell
fro
m 2
4.9
% i
n A
pri
l 2
00
0 t
o 1
7.5
% i
n
Ap
ril 2
008
, b
efo
re in
cre
asin
g a
ga
in t
o 2
0.4
% in
Ap
ril 2
011
. A
la
rge
pro
po
rtio
n
of
the
in
itia
l de
clin
e w
as d
ue t
o a
fa
ll i
n t
he
num
be
r o
f ch
ildre
n r
elia
nt
on
un
em
plo
ym
en
t b
ene
fit
recip
ien
ts (
fro
m 4
.5%
of
ch
ildre
n i
n 2
000
to
0.5
% i
n
Ap
ril 2
008
, b
efo
re incre
asin
g t
o 1
.4%
in
Ap
ril 2
011
). T
he
pro
po
rtio
n o
f child
ren
relia
nt
on
DP
B r
ecip
ien
ts a
lso
fe
ll, f
rom
17
.2%
of
child
ren i
n A
pri
l 20
00
, to
1
3.8
% in
Ap
ril 2
008
, b
efo
re in
cre
asin
g to
15
.8%
in
Ap
ril 20
11
.
At
the
en
d o
f A
pril
201
1,
the
re w
ere
36
,095
child
ren
ag
ed
0–
18
ye
ars
wh
o
we
re r
elia
nt
on
a b
en
efit
or
be
ne
fit
recip
ien
t an
d w
ho
re
ceiv
ed
th
eir
be
nefits
fr
om
Se
rvic
e C
en
tres in
th
e N
els
on
Ma
rlb
oro
ug
h (
n=
5,5
35
), S
ou
th C
an
terb
ury
(n
=1
,96
5),
C
an
terb
ury
(n
=1
8,1
77
), W
est
Coast
(n=
1,1
59
), O
tag
o (n
=5
,19
8)
an
d
So
uth
lan
d
(n=
4,0
61
) D
HB
ca
tchm
en
ts.
While
th
e
ma
jority
o
f th
ese
ch
ildre
n w
ere
re
lian
t on
DP
B r
ecip
ien
ts,
incre
ases i
n t
he n
um
be
r re
liant
on
un
em
plo
ym
en
t b
en
efit
recip
ien
ts w
ere
evid
en
t be
twe
en
Apri
l 2
00
8 a
nd
Ap
ril
20
11
.
Intr
odu
ctio
n a
nd
Ove
rvie
w -
43
Ind
ica
tor
New
Ze
ala
nd
Dis
trib
utio
n a
nd
Tre
nd
s
So
uth
Isla
nd
Dis
trib
utio
n a
nd
Tre
nd
s
Hea
lth
an
d W
ellb
ein
g In
dic
ato
rs
Hosp
ita
l A
dm
issio
ns
an
d M
ort
alit
y w
ith
a
So
cia
l G
rad
ien
t
In N
ew
Ze
ala
nd
du
ring
20
06
–2
01
0,
ga
str
oe
nte
ritis,
bro
nchio
litis
, a
nd
asth
ma
we
re th
e le
ad
ing
ca
use
s o
f h
ospita
lisa
tion
s fo
r m
ed
ica
l co
nd
itio
ns w
ith
a
so
cia
l g
radie
nt,
wh
ile f
alls
, fo
llow
ed
by i
na
nim
ate
mech
an
ical
forc
es w
ere
th
e
lea
din
g c
au
se
s o
f in
jury
adm
issio
ns.
Durin
g 2
004
–20
08
SU
DI
wa
s t
he
le
ad
ing
ca
use
of
mo
rta
lity w
ith
a s
ocia
l g
rad
ien
t. V
eh
icle
occup
an
t d
ea
ths,
follo
we
d b
y
pe
destr
ian
in
juries
and
d
row
nin
g,
ma
de
the
larg
est
co
ntr
ibu
tio
n
to
inju
ry
rela
ted
d
ea
ths,
wh
ile b
acte
ria
l/n
on
-vir
al
pne
um
on
ia w
as th
e le
ad
ing
ca
use
fro
m m
edic
al co
nditio
ns.
Me
dic
al
adm
issio
ns w
ith
a s
ocia
l g
rad
ient
incre
ased
du
rin
g t
he
ea
rly 2
00
0s,
rea
che
d p
eak in
20
02 a
nd
then
declin
ed
, w
ith
an u
psw
ing
in
ra
tes a
ga
in b
ein
g
evid
en
t d
urin
g 2
00
7–
20
09
. In
co
ntr
ast, i
nju
ry a
dm
issio
ns d
eclin
ed
th
roug
ho
ut
20
00
–2
010
. D
uri
ng
th
is p
eriod
, h
osp
italis
atio
ns f
or
me
dic
al
co
nd
itio
ns w
ere
h
igh
er
for
Pa
cific
> M
āo
ri >
Eu
rop
ean
an
d A
sia
n/In
dia
n c
hild
ren
. F
or
Pacific
ch
ildre
n,
rate
s incre
ased
du
ring
th
e e
arl
y 2
00
0s,
reach
ed
a p
ea
k in
20
03
and
the
n d
eclin
ed
. A
n u
psw
ing
in
ra
tes w
as a
gain
evid
ent
duri
ng 2
007
–2
00
9,
with
rate
s t
hen
declin
ing
du
ring
201
0.
For
Mā
ori
child
ren
, ra
tes w
ere
sta
tic d
uri
ng
the
mid
-20
00s,
bu
t th
en
in
cre
ase
d d
urin
g 2
00
7–
20
09
, w
hile
fo
r A
sia
n/I
ndia
n
an
d E
uro
pea
n c
hild
ren
ra
tes w
ere
sta
tic d
urin
g t
he
mid
-200
0s b
ut
incre
ased
aft
er
200
7.
Inju
ry
ad
mis
sio
ns
with
a
so
cia
l g
rad
ien
t w
ere
a
lso
hig
he
r fo
r P
acific
an
d M
āo
ri >
E
uro
pean
>
Asia
n/I
nd
ian
child
ren
. A
dm
issio
n ra
tes fo
r E
uro
pe
an
a
nd
M
āo
ri
child
ren
d
eclin
ed
d
urin
g
20
00
–2
010
, w
hile
ra
tes
for
Pa
cific
an
d A
sia
n/I
nd
ian c
hild
ren
we
re m
ore
sta
tic.
In
the
So
uth
Is
lan
d
du
ring
2
00
6–2
010
, ho
spita
l a
dm
issio
ns
for
me
dic
al
co
nditio
ns
with
a
socia
l g
rad
ien
t w
ere
sig
nific
an
tly
low
er
tha
n
the
N
ew
Z
ea
lan
d r
ate
in
all
DH
Bs.
While
in
jury
adm
issio
ns w
ith
a s
ocia
l g
rad
ien
t w
ere
a
lso
sig
nific
an
tly lo
we
r th
an
the
New
Ze
ala
nd
ra
te in
Nels
on
Ma
rlb
oro
ug
h a
nd
Ota
go
, ra
tes in
So
uth
Can
terb
ury
, th
e W
est
Coa
st,
Can
terb
ury
an
d S
ou
thla
nd
we
re s
imila
r to
th
e N
ew
Ze
ala
nd
ra
te.
Asth
ma
, ga
str
oe
nte
ritis a
nd
up
pe
r re
spir
ato
ry t
ract
infe
ction
s w
ere
th
e m
ost
fre
qu
en
t re
ason
s
for
ho
sp
italis
atio
ns
for
me
dic
al
con
ditio
ns
with
a
socia
l g
rad
ien
t in
th
e S
ou
th I
sla
nd D
HB
s,
alth
ou
gh v
ira
l in
fectio
ns o
f u
nspe
cifie
d s
ite
an
d b
ronch
iolit
is als
o m
ad
e a
co
ntr
ibu
tio
n in
so
me
D
HB
s.
Infe
ctiou
s a
nd
re
sp
ira
tory
dis
eases c
olle
ctively
we
re r
esp
on
sib
le f
or
the
ma
jori
ty o
f m
ed
ica
l a
dm
issio
ns d
urin
g t
his
pe
riod.
Fa
lls a
nd
in
anim
ate
mech
an
ical
forc
es w
ere
th
e m
ost
freq
uen
t re
aso
ns f
or
inju
ry a
dm
issio
ns w
ith
a s
ocia
l g
radie
nt
in a
ll D
HB
s,
alth
ou
gh
tr
anspo
rt
inju
ries
as
a
gro
up
a
lso
m
ad
e
a
sig
nific
ant
co
ntr
ibu
tio
n.
Inju
rie
s A
risin
g f
rom
th
e A
ssa
ult,
Neg
lect
an
d M
altre
atm
en
t o
f C
hild
ren
In N
ew
Ze
ala
nd
du
rin
g 2
00
6–2
01
0,
ho
spital
ad
mis
sio
ns f
or
inju
rie
s s
usta
ined
as t
he
resu
lt o
f th
e a
ssau
lt,
neg
lect
or
ma
ltre
atm
en
t o
f ch
ildre
n e
xh
ibite
d a
U-
sh
ape
d d
istr
ibutio
n w
ith
ag
e,
with
ra
tes b
ein
g h
ighe
st
for
infa
nts
< 1
yea
r, a
nd
tho
se
> 1
1 y
ea
rs o
f a
ge
. In
con
tra
st, m
ort
alit
y w
as h
ighe
st
for
infa
nts
< 1
ye
ar.
W
hile
the
gen
de
r b
ala
nce
fo
r a
dm
issio
ns w
as r
ela
tive
ly e
ve
n d
uri
ng i
nfa
ncy
an
d e
arly c
hild
hoo
d,
ho
sp
ital ad
mis
sio
ns f
or
ma
les b
ecam
e m
ore
pre
dom
ina
nt
as a
do
lesce
nce
ap
pro
ach
ed
. In
add
itio
n,
adm
issio
ns w
ere
als
o s
ignific
an
tly
hig
he
r fo
r m
ale
s,
Mā
ori
>
P
acific
>
E
uro
pe
an
>
Asia
n/In
dia
n ch
ildre
n,
an
d
tho
se
in
ave
rag
e-t
o-m
ore
de
prive
d (
NZ
De
p d
ecile
2–
10)
are
as.
In C
an
terb
ury
du
rin
g 2
00
6–
201
0,
hosp
ita
l a
dm
issio
ns f
or
inju
rie
s a
risin
g f
rom
th
e a
ssa
ult,
ne
gle
ct
or
ma
ltre
atm
en
t of
ch
ildre
n w
ere
sig
nific
an
tly h
igh
er
tha
n
the
New
Ze
ala
nd
ra
te,
wh
ile i
n t
he
rem
ain
ing
So
uth
Isla
nd
DH
Bs r
ate
s w
ere
n
ot
sig
nific
an
tly d
iffe
ren
t fr
om
th
e N
ew
Ze
ala
nd r
ate
. D
urin
g 2
00
0–2
00
8,
a
tota
l of
14
S
ou
th Is
lan
d ch
ildre
n d
ied
a
s t
he
re
su
lt o
f in
juri
es a
risin
g fr
om
a
ssa
ult,
neg
lect
or
maltre
atm
en
t.